VOL.
No.
125,
a
Downloaded from www.ajronline.org by 189.219.165.36 on 06/21/16 from IP address 189.219.165.36. Copyright ARRS. For personal use only; all rights reserved
ANGIOCARDIOGRAPHY RAPID CASSETTE MARIO
By
CORNALI,
M.D.,
WITH CHANGER
GAETANO
AZZOLINA, MASSA,
SMALL-SIZE FILMS*
M.D.,
SOFIA
and
REDAELLI,
M.D.
ITALY
ABSTRACT:
The disadvantages of small-size loX 10 cm. films in angiocardiography do not preclude correct diagnosis in a well equipped cardiac laboratory. On the contrary, the advantages are such as to recommend a more extensive use. In our department the method has been limited to pediatric patients, mainly because of excessive scattered radiation at high kVp. It is hopeful that improvement in recording and combination with image intensification will make the system available in the future for adult use. can
are
be performed according to various techniques each ofwhich has its advantages and disadvantages. Full size roentgenograms have the most desirable definition, but are difficult to handle and relatively ex-
tors
have
a capacity
and
can
be triggered
N
angiocardiographic
pensive.
Spot
practical
examination
films
are
to handle
less
but,
expensive,
at the
direction.
time,
with the equipment generally available, are lacking in definition. Cine-films offer the advantage of a dynamic approach, but they require an extensive investment and, for publication
purposes,
For patients we have been small-size,
have
limited
than that
films.
This
IOXIO
cm.
Cassette Changer fluorography, has
method, several
made
25 Kg utilizes
Rapid
based on photoadvantages.
TECHNIQUE
The two recording cameras, for horizontal and vertical projections, are of the kind commercially available for mass chest sunveys and are manufactured according to photofluoroscopic principles. The cameras allow 6 programs of films each, at a speed of 6, , 2, I , on films per second. A specially
designed
posune
of
I
projection,
electronic
film is
Roentgenographic lOX
10 cm.
processed. S
From
being
device
films
Department
in the
moved
in
which
processing, ofPediatric
allows
another,
events Fast
the
while
are can
Cardiothoracic
ex-
power
points,
when
moved
in position of
receiving
on
zine
tire minutes.
films Surgery,
genera-
alternatively
Kg
10
patient,
kVp
130
for each mAs and cm. with
40
pressure
injectors.
Studies
the
table
over
centering
is
top
and
the
cameras.
possible
tubes
are
This
because
the
top to image amplifier distance coinwith table top to camera grid distance. Thus, no geometrical error is intro-. duced by centering. Following exposure, the loX 10 cm. films are removed from the
position.
second
a
power mAs,
1200
table cides
be automatically 90
with
kind
other
recorded
For
The of
are always made in anteropostenion and lateral projections. For night-sided injection, 25 films in each projection are usually sufficient in our experience. In order to record a small field-size and to avoid unnecessary scattered radiation, the area to be necorded is previously viewed on a monitor. The tube centering light must coincide with this area. Small pen-marks are printed on the skin at the light field edges. These marks are used, subsequently, as reference
value.
weighing less using a system
available.
8 kVp, at a focus distance of 8 a I 2 : I grid, are required. Catheterization is usually performed through a brachial vessel, the internal jugular vein, on the common carotid artery.’ Injections are
more
present
presently
Ospedale
259
magazine,
loaded
and automatically examination is
Generale
Provinciale,
541oo
in a new
maga-
processed. An available within
Massa,
Italy.
en16
Cornali,
Downloaded from www.ajronline.org by 189.219.165.36 on 06/21/16 from IP address 189.219.165.36. Copyright ARRS. For personal use only; all rights reserved
260
FIG.
I.
An entire
right
and
Azzolina
left heart
examination
DISCUSSION
In evaluating an angiocardiographic a complete view of all the films most
desirable.
sible
with
This full-size
cm.
roentgenograms.
lOX
10
JoX group
10
mit
cm.
cm. (a)
are
films
used
very
for
heart
(c)
to
full can
examination
are
size to
view on
35 X35
or
other
children
to
pos-
hand,
feasible. handle,
and
convenient
A radiologist
the this
easy
not
cm.
On make
studies,
compared
extremely left
24X3o
films
study, available is
however,
roentgenographically
acceptable
( as
is,
The
by (b)
our per-
films
(d)
can
are
file.
SEPTEMBER,
be displayed
(Fig.
I).
The
films
is
reduced
time
of
5
take
them
facility
on a single
time
as down.
with
view
required to
seconds
films
playing
a
box.
for
handling
minimum,
being
a
required
opposed
to
films
mean
for
dis-
seconds
20
Furthermore,
which
1975
to
given can
be
the
handled,
the surgeon can be offered the unique opportunity of having the entire study in the operating cause
economical
and
Redaelli
room.
Definition,
diagnostically
quite
and
sharpness,
of minification
tical rather than roentgenologically
an entire
right
and
shows
a single
view
box
grams.
a
the
the
an electronic acceptable.
I : I reproduction
With
and and
aid
contrast,
be-
use
op-
of an
system, Figure of
are 2
6 roentgeno-
of a magnifying
lens,
125,
Downloaded from www.ajronline.org by 189.219.165.36 on 06/21/16 from IP address 189.219.165.36. Copyright ARRS. For personal use only; all rights reserved
VOL.
No.
Angiocandiography
a
26!
I FIG.
2.
A a : reproduction
of 6 cases
lens minor
of congenital
details
heart
disease.
can be sufficiently
With
evaluated.
the
aid
of a magnifying
Connali,
262
Downloaded from www.ajronline.org by 189.219.165.36 on 06/21/16 from IP address 189.219.165.36. Copyright ARRS. For personal use only; all rights reserved
even ated.
minor details A magnifying
mercially tions
can
available. have
been
nostic
anatomic
The this
cost
method
the
is less
being
technician small-size
can films
number
has
been
for
Furthermore,
load, unload, much faster more
with of con-
automated,
cm.
an x-ray
and process o than an equal
films.
This
leaves
and
useful
practical,
work. The space required for filing full-size films is considerable. With our method over examinations
3,000
can
be
filed
in order
3 small cabinets. The compactness age also reduces retrieval time help to busy file-clerks. As compared to roentgenography, fluorography has the following
in
of stor-
and
is of
photodisadvan-
The resolution achieved by the presently available photofluorographic system is infenior to that achieved in roentgenography. The modulation transfer function for photofluorography is inferior to that offered by Nonetheless,
as
our
ex-
penience proves, the system allows highly acceptable diagnostic opportunities. Since angiocandiographic examinations are correlated with oxygen saturation studies, electrocardiograms, torcardiograms, offset
by
phonocardiograms, this disadvantage these
additional
partment
70
mm.
cine-flims
are
also
to switch Scattered
come cian.
to these radiation,
films
available.
methods
In
and This
when
if excessive,
a serious problem for For patients weighing
SEPTEMBER,
our
i6
de-
our camera requires more than in order to have sufficient penetration
and
to
avoid
excessive
entails
amount
that
may
become
the diagnostimore than
loads.
This,
of
radiation
in
an
roentgenographi-
undesirable. Furthermore, the use of kVp reduces contrast, increases latiand makes the film appear too “flat.” these reasons we limit the use of the to patients weighing less than 25 In addition, for the purpose of reduc-
ing
secondary
tube, x-ray
radiation
a,n electronic tubes alternately.
from device This
the
second
triggers circuitry
the per-
mits exposure of i film while the other being moved in position. In roentgenography it is necessary keep the radiation dose to a minimum. method requires a higher radiation than conventional roentgenography. instance, at a focus-film distance of 8 with
a
diac
i:
grid,
I
mAs
40
and
8
kVp
2
is
to Our dose For cm. are
patients
where
Mario
Cornali,
Ospedale 54100
is
M.D.
Generale Massa, Italy
Provinciale
The authors wish to thank Miss Anna Frezzato for her assistance in the preparation of the manuscript. REFERENCES
I.
G.,
AZZOLINA,
approach and
S., and ALELLA, catheterization
EUFRATE,
to cardiac
children.
Brit.
Heart7.,
R. H. Frequency
MORGAN,
valuable
means
cording
capability
AM.
25
diagnosis
Cardiochirurgia
2.
be-
thorough
an essential feature.
us
needed. may
tube
scattered
100
cally high tude, For system Kg.
mm.
allows
1975
Kg, kVp
and veccan be
data.
spot
Redaelli
required for a 10 Kg patient. However, given the undisputed advantages of smallsize films, a higher radiation dosage is not considered detrimental for congenital car-
tages.
roentgenography.2
and
course,
with
obtained.
of an examination than 1/10 that
fully
35 X35
of free
1967
most of the patients been operated upon, it stated that good diag-
roentgenography.
system
him
since
control
average
ventional
be sufficiently evaluview box is also comOver 3,000 examina-
performed
this method. Since have subsequently can be confidently
Azzolina
J.
CLEARMED.,
of expressing of diagnostic
ROENTGENOL.,
1962,88,
1973,35,
response
RAD. 175-186.
A. New
in infants 643-646. function:
informational x-ray THERAPY
re-
systems. & NU-
No.
125,
a
Downloaded from www.ajronline.org by 189.219.165.36 on 06/21/16 from IP address 189.219.165.36. Copyright ARRS. For personal use only; all rights reserved
ANGIOCARDIOGRAPHY RAPID CASSETTE MARIO
By
CORNALI,
M.D.,
WITH CHANGER
GAETANO
AZZOLINA, MASSA,
SMALL-SIZE FILMS*
M.D.,
SOFIA
and
REDAELLI,
M.D.
ITALY
ABSTRACT:
The disadvantages of small-size loX 10 cm. films in angiocardiography do not preclude correct diagnosis in a well equipped cardiac laboratory. On the contrary, the advantages are such as to recommend a more extensive use. In our department the method has been limited to pediatric patients, mainly because of excessive scattered radiation at high kVp. It is hopeful that improvement in recording and combination with image intensification will make the system available in the future for adult use. can
are
be performed according to various techniques each ofwhich has its advantages and disadvantages. Full size roentgenograms have the most desirable definition, but are difficult to handle and relatively ex-
tors
have
a capacity
and
can
be triggered
N
angiocardiographic
pensive.
Spot
practical
examination
films
are
to handle
less
but,
expensive,
at the
direction.
time,
with the equipment generally available, are lacking in definition. Cine-films offer the advantage of a dynamic approach, but they require an extensive investment and, for publication
purposes,
For patients we have been small-size,
have
limited
than that
films.
This
IOXIO
cm.
Cassette Changer fluorography, has
method, several
made
25 Kg utilizes
Rapid
based on photoadvantages.
TECHNIQUE
The two recording cameras, for horizontal and vertical projections, are of the kind commercially available for mass chest sunveys and are manufactured according to photofluoroscopic principles. The cameras allow 6 programs of films each, at a speed of 6, , 2, I , on films per second. A specially
designed
posune
of
I
projection,
electronic
film is
Roentgenographic lOX
10 cm.
processed. S
From
being
device
films
Department
in the
moved
in
which
processing, ofPediatric
allows
another,
events Fast
the
while
are can
Cardiothoracic
ex-
power
points,
when
moved
in position of
receiving
on
zine
tire minutes.
films Surgery,
genera-
alternatively
Kg
10
patient,
kVp
130
for each mAs and cm. with
40
pressure
injectors.
Studies
the
table
over
centering
is
top
and
the
cameras.
possible
tubes
are
This
because
the
top to image amplifier distance coinwith table top to camera grid distance. Thus, no geometrical error is intro-. duced by centering. Following exposure, the loX 10 cm. films are removed from the
position.
second
a
power mAs,
1200
table cides
be automatically 90
with
kind
other
recorded
For
The of
are always made in anteropostenion and lateral projections. For night-sided injection, 25 films in each projection are usually sufficient in our experience. In order to record a small field-size and to avoid unnecessary scattered radiation, the area to be necorded is previously viewed on a monitor. The tube centering light must coincide with this area. Small pen-marks are printed on the skin at the light field edges. These marks are used, subsequently, as reference
value.
weighing less using a system
available.
8 kVp, at a focus distance of 8 a I 2 : I grid, are required. Catheterization is usually performed through a brachial vessel, the internal jugular vein, on the common carotid artery.’ Injections are
more
present
presently
Ospedale
259
magazine,
loaded
and automatically examination is
Generale
Provinciale,
541oo
in a new
maga-
processed. An available within
Massa,
Italy.
en16
Cornali,
Downloaded from www.ajronline.org by 189.219.165.36 on 06/21/16 from IP address 189.219.165.36. Copyright ARRS. For personal use only; all rights reserved
260
FIG.
I.
An entire
right
and
Azzolina
left heart
examination
DISCUSSION
In evaluating an angiocardiographic a complete view of all the films most
desirable.
sible
with
This full-size
cm.
roentgenograms.
lOX
10
JoX group
10
mit
cm.
cm. (a)
are
films
used
very
for
heart
(c)
to
full can
examination
are
size to
view on
35 X35
or
other
children
to
pos-
hand,
feasible. handle,
and
convenient
A radiologist
the this
easy
not
cm.
On make
studies,
compared
extremely left
24X3o
films
study, available is
however,
roentgenographically
acceptable
( as
is,
The
by (b)
our per-
films
(d)
can
are
file.
SEPTEMBER,
be displayed
(Fig.
I).
The
films
is
reduced
time
of
5
take
them
facility
on a single
time
as down.
with
view
required to
seconds
films
playing
a
box.
for
handling
minimum,
being
a
required
opposed
to
films
mean
for
dis-
seconds
20
Furthermore,
which
1975
to
given can
be
the
handled,
the surgeon can be offered the unique opportunity of having the entire study in the operating cause
economical
and
Redaelli
room.
Definition,
diagnostically
quite
and
sharpness,
of minification
tical rather than roentgenologically
an entire
right
and
shows
a single
view
box
grams.
a
the
the
an electronic acceptable.
I : I reproduction
With
and and
aid
contrast,
be-
use
op-
of an
system, Figure of
are 2
6 roentgeno-
of a magnifying
lens,
125,
Downloaded from www.ajronline.org by 189.219.165.36 on 06/21/16 from IP address 189.219.165.36. Copyright ARRS. For personal use only; all rights reserved
VOL.
No.
Angiocandiography
a
26!
I FIG.
2.
A a : reproduction
of 6 cases
lens minor
of congenital
details
heart
disease.
can be sufficiently
With
evaluated.
the
aid
of a magnifying
Connali,
262
Downloaded from www.ajronline.org by 189.219.165.36 on 06/21/16 from IP address 189.219.165.36. Copyright ARRS. For personal use only; all rights reserved
even ated.
minor details A magnifying
mercially tions
can
available. have
been
nostic
anatomic
The this
cost
method
the
is less
being
technician small-size
can films
number
has
been
for
Furthermore,
load, unload, much faster more
with of con-
automated,
cm.
an x-ray
and process o than an equal
films.
This
leaves
and
useful
practical,
work. The space required for filing full-size films is considerable. With our method over examinations
3,000
can
be
filed
in order
3 small cabinets. The compactness age also reduces retrieval time help to busy file-clerks. As compared to roentgenography, fluorography has the following
in
of stor-
and
is of
photodisadvan-
The resolution achieved by the presently available photofluorographic system is infenior to that achieved in roentgenography. The modulation transfer function for photofluorography is inferior to that offered by Nonetheless,
as
our
ex-
penience proves, the system allows highly acceptable diagnostic opportunities. Since angiocandiographic examinations are correlated with oxygen saturation studies, electrocardiograms, torcardiograms, offset
by
phonocardiograms, this disadvantage these
additional
partment
70
mm.
cine-flims
are
also
to switch Scattered
come cian.
to these radiation,
films
available.
methods
In
and This
when
if excessive,
a serious problem for For patients weighing
SEPTEMBER,
our
i6
de-
our camera requires more than in order to have sufficient penetration
and
to
avoid
excessive
entails
amount
that
may
become
the diagnostimore than
loads.
This,
of
radiation
in
an
roentgenographi-
undesirable. Furthermore, the use of kVp reduces contrast, increases latiand makes the film appear too “flat.” these reasons we limit the use of the to patients weighing less than 25 In addition, for the purpose of reduc-
ing
secondary
tube, x-ray
radiation
a,n electronic tubes alternately.
from device This
the
second
triggers circuitry
the per-
mits exposure of i film while the other being moved in position. In roentgenography it is necessary keep the radiation dose to a minimum. method requires a higher radiation than conventional roentgenography. instance, at a focus-film distance of 8 with
a
diac
i:
grid,
I
mAs
40
and
8
kVp
2
is
to Our dose For cm. are
patients
where
Mario
Cornali,
Ospedale 54100
is
M.D.
Generale Massa, Italy
Provinciale
The authors wish to thank Miss Anna Frezzato for her assistance in the preparation of the manuscript. REFERENCES
I.
G.,
AZZOLINA,
approach and
S., and ALELLA, catheterization
EUFRATE,
to cardiac
children.
Brit.
Heart7.,
R. H. Frequency
MORGAN,
valuable
means
cording
capability
AM.
25
diagnosis
Cardiochirurgia
2.
be-
thorough
an essential feature.
us
needed. may
tube
scattered
100
cally high tude, For system Kg.
mm.
allows
1975
Kg, kVp
and veccan be
data.
spot
Redaelli
required for a 10 Kg patient. However, given the undisputed advantages of smallsize films, a higher radiation dosage is not considered detrimental for congenital car-
tages.
roentgenography.2
and
course,
with
obtained.
of an examination than 1/10 that
fully
35 X35
of free
1967
most of the patients been operated upon, it stated that good diag-
roentgenography.
system
him
since
control
average
ventional
be sufficiently evaluview box is also comOver 3,000 examina-
performed
this method. Since have subsequently can be confidently
Azzolina
J.
CLEARMED.,
of expressing of diagnostic
ROENTGENOL.,
1962,88,
1973,35,
response
RAD. 175-186.
A. New
in infants 643-646. function:
informational x-ray THERAPY
re-
systems. & NU-
