Rotational angiography

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Rotational angiography
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Ceiling-mounted C-arm in a cardiac catheterization lab
Purposeacquire CT-like 3D volumes during hybrid surgery

Rotational angiography is a medical imaging technique based on x-ray, that allows to acquire CT-like 3D volumes during hybrid surgery or during a catheter intervention using a fixed C-Arm. The fixed C-Arm thereby rotates around the patient and acquires a series of x-ray images that are then reconstructed through software algorithms into a 3D image. [1] Synonyms for rotational angiography include flat-panel volume CT [2] and cone-beam CT. [1]

Contents

Technical background

In order to acquire a 3D image with a fixed C-Arm, the C-Arm is positioned at the body part in question so that this body part is in the isocenter between the x-ray tube and the detector. The C-Arm then rotates around that isocenter, the rotation being between 200° and 360° (depending on the equipment manufacturer). Such a rotation takes between 5 and 20 seconds, during which a few hundred 2D images are acquired. A piece of software then performs a cone beam reconstruction. The resulting voxel data can then be viewed as a multiplanar reconstruction, i.e. by scrolling through the slices from three projection angles, or as a 3D volume, which can be rotated and zoomed. [1] [3]

Clinical applications

3D angiography or Rotational Angiography is used in interventional radiology, interventional cardiology and minimally-invasive surgery (e.g., Hybrid cardiac surgical procedure ).[ citation needed ]

CT versus rotational angiography

Classically, CT imaging has been the method of choice for acquiring 3D data pre- or postoperatively. Choosing between CT and rotational angiography depends on several factors.

Image quality is not only defined through artifacts but also through temporal, spatial, and contrast resolution. The physical characteristics of a flat-panel detector decrease the temporal resolution as the one of the ceramic detectors used in multidetector CT systems. [3] By contrast, the spatial resolution of flat-panel volume CT (rotational angiography using a C-Arm) can be much better than that of a multislice CT scanner, with resolution ranges between 200 and 300 μm in high-resolution mode, compared to up to 600μm for a multislice CT. [2] Contrast resolution, measured in hounsfield units (HU), is only marginally inferior than with a multidetector CT, the difference in attenuation from the background being 5 HU with flat-panel volume CT (=rotational angiography) compared to 3 HU for a multidetector CT. This difference is negligible for most therapeutical applications. [2]

Radiation dose

X-ray radiation is ionizing radiation, thus exposure is potentially harmful. Compared to a mobile C-Arm, which is classically used in surgery, CT scanners and fixed C-Arms may deliver higher dose and may be operated for longer periods during surgery. It is therefore important to monitor radiation dose to both patient and the medical staff. [6]

Rotational angiography may increase the exposure of workers to scattered radiation, as the X-ray source moves around the patient. Lead curtains are often used at the table side to protect the lower body region, but these are less effective with rotational work. [7] Patient doses can be reduced with techniques common to fluoroscopic imaging such as use of pulsed modes, appropriate collimation and short imaging times. [8]

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<span class="mw-page-title-main">Radiography</span> Imaging technique using ionizing and non-ionizing radiation

Radiography is an imaging technique using X-rays, gamma rays, or similar ionizing radiation and non-ionizing radiation to view the internal form of an object. Applications of radiography include medical radiography and industrial radiography. Similar techniques are used in airport security. To create an image in conventional radiography, a beam of X-rays is produced by an X-ray generator and is projected toward the object. A certain amount of the X-rays or other radiation is absorbed by the object, dependent on the object's density and structural composition. The X-rays that pass through the object are captured behind the object by a detector. The generation of flat two dimensional images by this technique is called projectional radiography. In computed tomography an X-ray source and its associated detectors rotate around the subject which itself moves through the conical X-ray beam produced. Any given point within the subject is crossed from many directions by many different beams at different times. Information regarding attenuation of these beams is collated and subjected to computation to generate two dimensional images in three planes which can be further processed to produce a three dimensional image.

<span class="mw-page-title-main">Medical imaging</span> Technique and process of creating visual representations of the interior of a body

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<span class="mw-page-title-main">Fluoroscopy</span> Production of an image when X-rays strike a fluorescent screen

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<span class="mw-page-title-main">Coronary catheterization</span> Radiography of heart and blood vessels

A coronary catheterization is a minimally invasive procedure to access the coronary circulation and blood filled chambers of the heart using a catheter. It is performed for both diagnostic and interventional (treatment) purposes.

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<span class="mw-page-title-main">Computed tomography angiography</span>

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<span class="mw-page-title-main">CT pulmonary angiogram</span>

A CT pulmonary angiogram (CTPA) is a medical diagnostic test that employs computed tomography (CT) angiography to obtain an image of the pulmonary arteries. Its main use is to diagnose pulmonary embolism (PE). It is a preferred choice of imaging in the diagnosis of PE due to its minimally invasive nature for the patient, whose only requirement for the scan is an intravenous line.

<span class="mw-page-title-main">Automatic exposure control</span>

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<span class="mw-page-title-main">Cone beam computed tomography</span> Medical imaging technique

Cone beam computed tomography is a medical imaging technique consisting of X-ray computed tomography where the X-rays are divergent, forming a cone.

<span class="mw-page-title-main">Contrast CT</span>

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<span class="mw-page-title-main">Coronary CT angiography</span> Use of computed tomography angiography to assess the coronary arteries of the heart

Coronary CT angiography is the use of computed tomography (CT) angiography to assess the coronary arteries of the heart. The patient receives an intravenous injection of radiocontrast and then the heart is scanned using a high speed CT scanner, allowing physicians to assess the extent of occlusion in the coronary arteries, usually in order to diagnose coronary artery disease.

<span class="mw-page-title-main">Cardiac imaging</span>

Cardiac imaging refers to minimally invasive imaging of the heart using ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), or nuclear medicine (NM) imaging with PET or SPECT. These cardiac techniques are otherwise referred to as echocardiography, Cardiac MRI, Cardiac CT, Cardiac PET and Cardiac SPECT including myocardial perfusion imaging.

<span class="mw-page-title-main">Hybrid cardiac surgery</span>

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Jeffrey Harold Siewerdsen is an American physicist and biomedical engineer who is a Professor of Biomedical Engineering, Computer Science, Radiology, and Neurosurgery at Johns Hopkins University. He is Co-Director of the Carnegie Center for Surgical Innovation at Johns Hopkins School of Medicine and is a member of the Malone Center for Engineering in Healthcare. He is among the original inventors of cone-beam CT-guided radiotherapy as well as weight-bearing cone-beam CT for musculoskeletal radiology and orthopedic surgery. His work also includes the early development of flat-panel detectors on mobile C-arms for intraoperative cone-beam CT in image-guided surgery. He developed early models for the signal and noise performance of flat-panel detectors and later extended such analysis to dual-energy imaging and 3D imaging performance in cone-beam CT. His core laboratory at Johns Hopkins University is the ISTAR Lab in the Department of Biomedical Engineering at the Johns Hopkins Hospital.

References

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