Angiography Machine Research Articles

A mobile minimally invasive interventional shelter: a new answer to on-spot emergency treatment of large arterial injuries?

BackgroundSeverely destructive disasters can often lead to heavy casualties. Large arterial injury in disasters, particularly, often results in high mortality and morbidity. Although minimally invasive intervention has achieved positive effects in diagnosing and treating vascular injuries, it is still unavailable at the disaster area of any country due to lack of on-spot catheterization labs. This study aimed to test the feasibility of adopting interventional techniques to treat haemorrhage of large arterial injuries in remote and austere wild environments after severely destructive disasters, by using a new mobile intervention suite we developed—the mobile minimally invasive interventional shelter (MIS).MethodsLarge animal models of aortic and femoral arterial injuries were established using a newly developed medium vehicle-mounted digital subtraction angiography (DSA) machine in MIS. The endovascular stent-graft exclusion and balloon occlusion combined with surgical hemostasis were performed respectively following the protocols for rapid interventional therapy. The treatment capacity of the shelter was evaluated based on its stability, surgery duration and the clinical results.Results and discussionThe stability of the medical devices in MIS directly relates to the efficiency and success rate of interventional treatment. The newly developed vehicle-mounted DSA machine showed good imaging performance and the operation of all equipments and devices in MIS were stable in interventional procedures. All the interventional treatments for large arterial injuries were performed smoothly. The average time for treating abdominal aortic injury and femoral arterial injury was 23 ± 11 and 55 ± 17 min, respectively. And the operation success rate reached 100 %.ConclusionIt is feasible to perform interventional operations to control haemorrhage of large arterial injuries in MIS outside hospital. The MIS has a great potential to save patients from dying of hemorrhagic shock due to lack of effective treatment devices and approaches in remote and austere wild environments, such as in disaster areas.

Therapeutic angiographic procedures: differences in dose area product between analog image intensifier and digital flat panel detector.

Radiation exposure remains an unceasing concern in angiographic procedures. Modern angiography machines such as analog image intensifiers (AII) or the new flat panel detectors (FPD) aim at a further dose reduction. To present dose area products (DAP) in a broad spectrum of therapeutic angiographic procedures, comparing an AII to an FPD angiography system. A total of 999 peripheral therapeutic angiography procedures performed with an FPD (n = 562) and an AII system (n = 437) were evaluated. DAP, fluoroscopy time, and patients' body mass index (BMI) were recorded. Interventions were classified into five main groups: percutaneous transluminal angioplasty (PTA); PTA and stent placement; intra-arterial thrombolysis; embolization procedures; and specialized interventions. DAP values in therapeutic angiographic procedures were significantly higher when performed with the FPD compared to the AII system. The increase of the FPD versus AII system was 100.1% for PTA, 39.9% for PTA and stent placement, 187% for intra-arterial thrombolysis, 31.3% for embolization procedures, and 361% for specialized interventions. These differences persisted after standardizing DAP values to the geometric mean fluoroscopy duration of each procedure. Fluoroscopy times were shorter in all interventions performed at the FPD as compared to the AII system. DAPs increased with higher BMI, but the DAP increase of both systems with elevated BMI was variable, depending on the individual intervention. In therapeutic angiographic procedures, the FPD system required higher DAPs despite shorter fluoroscopy times as compared to an AII system. Better ergonomics and speediness of the FPD system may be advantageous in the emergency setting.

Clinical application of a vascular interventional robot in cerebral angiography.

Cardiovascular and cerebrovascular diseases have become the leading cause of death for people, and endovascular surgery has become the main therapeutic method. Robot technology would overcome some limitations of conventional surgery, and has good prospects. A total of 15 patients received cerebral angiography assisted by a vascular interventional robot following preoperative examination, with approval from the hospital ethics committee and informed consent by the patients' families. Robot-assisted angiography was performed quickly and smoothly without surgical complications. The remote positioning accuracy was 1.05 ± 0.28 mm. The time staff were exposed to the digital subtraction angiography (DSA) machine was 0 min. The entire experimental process was mechanized and automated. This system achieved the preliminary purposes, including a reduction in radiation for the surgeons, facilitation of the application of interventional procedures, a decrease in operation time, and an improvement in operation quality.

Risk factors of radiation dose in patients undergoing peripherally-inserted central catheter procedure using conventional angiography equipment and flat panel detector-based mobile C-arm fluoroscopy

Although peripherally-inserted central catheter (PICC) insertion is commonly performed under fluoroscopic guidance, few reports have addressed performance and dosimetry when PICC is inserted under C-arm fluoroscopy. To evaluate the risk factors of radiation dose in performing PICC insertion using flat panel detector-based mobile C-arm fluoroscopy and a conventional angiography machine. Ninety-eight patients underwent the PICC procedure using conventional angiography equipment (n=49) or flat panel detector-based mobile C-arm fluoroscopy (n=49). Data were prospectively analyzed from July to November 2012. Dose-area product (DAP), tube voltage, tube current, fluoroscopy time, and image quality measured on a 5-point scale were estimated and compared using appropriate statistical tests. There were no significant differences in tube voltage, fluoroscopy time, and image quality between conventional angiography and mobile C-arm fluoroscopy. DAP, mean arm tube current, and tube current in chest fluoroscopy were significantly lower in mobile C-arm fluoroscopy than using the conventional angiography machine (P < 0.05). Multivariate analysis identified tube current in chest fluoroscopy, arm tube current, and fluoroscopy equipment as significant risk factors for elevated radiation dose in PICC insertion. PICC insertion can be performed using flat panel detector-based mobile C-arm fluoroscopy instead of a conventional angiography machine. Image quality and fluoroscopy time were not different between the two systems and the use of C-arm fluoroscopy significantly reduced radiation dose.

Emergency treatment of splenic injury in a novel mobile minimally invasive interventional shelter following disaster: a feasibility study.

BackgroundThere has been an increase in natural disasters in recent years, which leads to a great number of injuries and deaths. It still remains an unsolved problem to treat patients with vascular injury of solid organs effectively following natural disasters, but on-spot emergency interventional transcatheter arterial embolization (TAE) has been highly recommended to cure serious vascular injury of solid organs nowadays. Spleen is the most vulnerable abdominal organ, severe arterial hemorrhage of which can cause death if untreated timely. In this research, we aimed to study the possibility of performing emergency surgical intervention in mobile minimally invasive interventional shelter for splenic injury in the case of natural disasters.MethodsFirst, the mobile minimally invasive interventional shelter was unfolded in the field, and then disinfection and preoperative preparation were performed immediately. Eight large animal models of splenic injury were created, and angiograms were performed using a digital subtraction angiography machine in the mobile minimally invasive interventional shelter, and then the hemostatic embolizations of injured splenic artery were performed following the established convention of rapid intervention therapy. The operating time was recorded, and the survival condition and postoperative complications were observed for two weeks.Results and discussionThe average time of unfolding the shelter, and performing disinfection and preoperative preparation was 33 ± 7 min. The number of colonies in the sterilized shelter body was 86 ± 13 cfu/m3. The average TAE time was 31 ± 7 min. All the hemostatic embolizations of splenic injury were performed successfully in the mobile minimally invasive interventional shelter during the operation. A pseudoaneurysm was found in an animal model using angiography two weeks after the operation. The primary clinical success rate of embolization was 87.5%. The two-week survival rate in all animal models of splenic injury was 100%.ConclusionsOur findings in the current study demonstrate that the mobile minimally invasive interventional shelter can be adapted to the field perfectly and complete emergency surgical intervention for splenic injury efficiently and safely. Therefore, on-spot emergency interventional TAE for vascular injury of solid organs (e.g. spleen) in mobile minimally invasive interventional shelter is available and effective.

GW24-e1754 Development and application of vehicle-mounted medium C shaped brachial angiography machine system

ObjectivesThere is no report about the vehicle-mounted medium C shaped brachial angiography machine system. This styday adapt to the field of minimally invasive operation module to achieve its interventional operation...

Eye lens dosimetry in interventional cardiology: results of staff dose measurements and link to patient dose levels

Workers involved in interventional cardiology procedures receive high eye lens dose if protection is not used. Currently, there is no suitable method for routine use for the measurement of eye dose. Since most angiography machines are equipped with suitable patient dosemeters, deriving factors linking staff eye doses to the patient doses can be helpful. In this study the patient kerma-area product, cumulative dose at an interventional reference point and eye dose in terms of Hp(3) of the cardiologists, nurses and radiographers for interventional cardiology procedures have been measured. Correlations between the patient dose and the staff eye dose were obtained. The mean eye dose was 121 µSv for the first operator, 33 µSv for the second operator/nurse and 12 µSv for radiographer. Normalised eye lens doses per unit kerma-area product were 0.94 µSv Gy⁻¹ cm⁻² for the first operator, 0.33 µSv Gy⁻¹ cm⁻² for the second operator/nurse and 0.16 µSv Gy⁻¹ cm⁻² for radiographers. Statistical analysis indicated that there is a weak but significant (p < 0.01) correlation between the eye dose and the kerma-area product for all three staff categories. These values are based on a local practice and may provide useful reference for other studies for validation and for wider utilisation in assessing the eye dose using patient dose values.

Comparison of Digital Flat-Panel Detector and Conventional Angiography Machines: Evaluation of Stent Detection Rates, Visibility Scores, and Dose-Area Products

The objective of this study was to compare the performance and radiation doses of a flat-panel detector (FPD) angiography machine with an image intensifier (II) angiography machine. Images of four nitinol stents (Sinus-SuperFlex, SMART, Luminexx, and Zilver stents) in a phantom of a human pelvis were acquired on an FPD system (Axiom Artis) and an II system (Fluorospot TOP) using the following modes: spot-film, continuous fluoroscopy (4, 7.5, 15, and 30 pulses/s), and three amplification modes. Objective stent detection rates and subjective radiopacity scores (scale: 0 [not visible] to 4 [excellent visibility]) were calculated. The radiation doses evaluated by the respective machines were compared. Over all modes and stents, the mean objective correct stent detection rates and mean subjective radiopacity scores were 89.49% and 1.81, respectively, for the Axiom Artis and 91.00% and 2.26 for the Fluorospot TOP. The stent detection rates over all modes for the SMART and Luminexx stents were better using the Axiom Artis machine (97.61% vs 93.55% and 98.28% vs 90.41%, respectively) and those for the Sinus-SuperFlex and Zilver stents were better using the Fluorospot TOP machine (90.83% vs 83.56% and 89.29% vs 80.50%). The subjective radiopacity scores of stent visibility were worse for the Axiom Artis than the Fluorospot TOP for all stents except the Luminexx stent (mean score, 2.34 vs 2.21, respectively). The objective stent detection rates and subjective radiopacity scores improved using the spot-film mode and with raising amplification, whereas increases in the fluoroscopy pulsing frequency did not improve stent detection rates or radiopacity scores for either machine. The radiation doses at continuous fluoroscopy were approximately 90% higher for the Axiom Artis than for the Fluorospot TOP (2.60 vs 1.41 μGy/m(2) at 30 pulses/s, respectively). The objective correct stent detection rates were similar for both machines with differences in detection for the respective stents. The subjective radiopacity scores were almost always better for the Fluorospot TOP machine. Also, the Axiom Artis machine generated approximately 90% higher radiation doses in fluoroscopy. For both machines, using a higher fluoroscopy pulsing frequency had no positive effect on objective correct stent detection rates or subjective radiopacity scores.

Experimental study of angiography using vascular interventional robot

To assess the feasibility and safety of vascular interventional surgery by using vascular interventional robot system (VIRS). VIRS included image navigation systems and body propulsion systems, and adopted a master-slave structure. The surgeon sat at the master site, sending controlling instructions to the robot fixed at the slave site, and then the robot translated these instructions into catheter motion. A 3D vascular model was reconstructed so that the surgeon can perform surgical planning easily. In glass model and animal experiments, the surgeon remotely controlled VIRS, which inserted a catheter into predefined targets, and the catheter positioning error and robotic surgery time were measured. The robot was initially tested on a glass vascular model. Under robotic manipulation, the catheter could enter an arbitrary branch of the vascular model. The catheter positioning error was less than 1 mm. Then robotic interventional surgery was performed successfully in ten adult dogs. The renal artery and the vertebral artery angiography carried out smoothly without complication. Experiment took 35 minutes, and the time what staff exposed to the digital subtraction angiography (DSA) machine was 0 minute. Vascular interventional surgical robot system is safe and feasible, and can achieve the catheter remote operation, meet the requirements of angiography basically.

Feasibility of establishing cerebral ischemia models by using aerocyst-blocking bilateral ascending pharyngeal artery of piglets: Imaging assessment

Background The cerebral ischemia and ischemia/reperfusion animal models are used to simulate the human cerebrovascular diseases is one of the popular topics of neurological science recently. To study the pathophysiology, pathogenesis, prophylaxis and treatment of ischemic cerebrovascular diseases and to establish the ideal animal model that is the most similar to the human cerebral ischemia, are the topics that the people generally cared about. Objective To evaluate the effects of aerocyst-blocking bilateral ascending pharyngeal artery on the establishment of cerebral ischemia models by using digital subtraction angiography (DSA), magnetic resonance diffusion-weighted imaging (DWI) and magnetic resonance perfusion-weighted imaging (PWI). Design Repetitive measure animal experiment. Setting Zhongshan Hospital Affiliated to Dalian University. Materials The experiment was carried out in the Animal Laboratory (Provincial Laboratory), Zhongshan Hospital of Dalian Univeristy from January to May 2006. A total of 14 domestic piglets, of 6 months old, weighing 12–15 kg, of either gender, were selected from Animal Experimental Center, Dalian University. Multistar T.O.P digital subtraction angiography machine was provided by Siemens Company, German. Methods Aerocyst-blocking bilateral ascending pharyngeal artery was used to establish cerebral ischemia models. And then, Multistar T.O.P. DSA was used for imaging of cerebral vessels before blocking, during blocking and at 0.5 and 2 hours after ischemia perfusion. GE Signa 1.5 T supraconduction magnetic resonance imaging was used for DWI examination; in addition, PWI was used based on focal sites and areas. Otherwise, magnetic resonance imaging (MRI) was used to detect signal changes of T1WI and T2WI in ischemic areas. Main outcome measures Analytic results of DSA, DWI, PWI and MRI. Results All 14 experimental piglets were involved in the final analysis. ▪ DSA: The blood flow of bilateral ascending pharyngeal arteries and its branch were blocked at blocking phase, which restored 0.5 and 2 hours after reperfusion. ▪ DWI and PWI: There were no observable abnormalities in PWI and DWI at pre-blocking. Abnormal increased signals were found on both DWI and PWI at during and post-blocking. There were reduction in ADC and rCBF and delay in rTTP at all time points except pre-blocking. ▪ MRI: There were no abnormal signals observable at any time of pre- and post-blocking in T1WI and T2WI. Conclusion It is feasible to establish this kind of animal experimental models, and it can simulate the ischemic state; meanwhile, the existence and extent can be showed directly by DSA, DWI, and PWI.

Radiology Image Management in a Teaching Hospital Network Scenario: Initial Experience.

INHS Asvini has the distinction of emerging as the first Armed Forces Hospital with networked radiology images, sourced principally from a recently installed Digital Substraction Angiography (DSA) machine (Siemens Polystar Top 1000 MA). In recent times, newer imaging machines offer digital images that are in DICOM format. DICOM denotes 'Digital Imaging and Communications in Medicine". Image management at INHS Asvini, involves transfer of DSA images in DICOM format, their conversion into Joint Photographic Experts Group (JPG) format and subsequent transmission of JPG images through a robust networking system that connects all departments/OPD/Wards, facilitating direct access of images to a variety of specialists and specialities. Clearly, this encouraging outcome is a small but useful step heralding the concept of 'anytime anywhere' images, and has the scalable expansibility of including CT and MRI images in future.

頭蓋外arterio-venous malformation (AVM) に対するintravascular surgery

We performed intravascular surgery on an extracranial AVM. Case 1: A 45-year-old female complained of a pulsatile tumor behind the left ear and of cosmetic problems, finding it hazardous to use a comb. Superselective angiography performed through the left occipital artery revealed a nidus (4×5cm) and drainers. Soon after, embolization with PVA (polyvinyl alcohol foam) was carried out and postoperative angiography showed the tumor to have disappeared. Three months later, a small tumor on the surface of the skin was resected. Pathohistological findings showed it to be a glomus tumor. Case 2: A 20-year-old male had suffered from a facial tumor since he was two years old. He had undergone coagulated ligation of the left common carotid artery and right peripheral facial artery. There was improvement of the tumor after this procedure, but it became enlarged about two years before admission to our hospital. A left VAG showed the muscle branch of the left vertebral artery communicating with the branch of the left external carotid artery, these vessels being the main suppliers of the tumor. Embolization (IBCA) was performed by direct puncture of the feeding arteries. A high quality angiography machine, the portable DSA (Diasonics) was used. The AVM has shown improvement but we intend to carry out further embolization. Embolization is now crucial in therapeutic angiography, and knowledge of its beneficial effects can help in the selection of appropriate cases. Skill, technique and excellent angiographical instruments are required. Embolization can in itself be a treatment or part of an over-all plan of therapy. One patient obtained a complete cure, while the other requires further embolization. It is our opinion that intravascular surgery is the first choice for treatment of extracranial AVM.

Ideal configuration for intravenous digital subtraction angiography machine.

An assessment of the current state of development of digital imaging systems is provided as well as recommendations for future areas of investigation, including the incorporation of large-field image intensifiers, higher raster rate TV systems, and high speed digital disks into digital subtraction angiography (DSA) machines. Recent advances in hardware and software developments are discussed as they pertain to the X-ray generator and tube, X-ray image sensors (image intensifiers and TV cameras), and the image processor of the DSA system.