-CT coronarography;

-CT of thoracic aorta with cardio protocol;

-Retrospective;

-Snap shot prospective

Pejkovik, Danijela

UGD Academic Repository

Cardiosurgery - Skopje64 ECG gated MSCT OF CORONARY ARTERIES AND ASCENDING AORTA- technical approachSpecial hospital for surgery diseases “Filip II”Rad.teh. Danijela PejkovikFebruary 2011Cardiosurgery - Skopje• CT coronarography• CT of thoracic aorta with cardio protocolRetrospectiveSnap shot prospective64 ECG gated MSCT OF CORONARY ARTERIES AND ASCENDING AORTA Cardiosurgery - Skopje64 ECG gated MSCT OF CORONARY ARTERIES AND ASCENDING AORTA • High speed scanning  (rot.time 0,35)• High spatial and temporal resolution• Thin slices - 0,625 mm, • Visualization in all planes (sagital, transversal, coronal)• Acquisition in diastolic phase What more we need?• An injector • ECG gating • 3D postprocesingCardiosurgery - Skopje• Patient preparation:    - patient history,  ЕCG / HR / ТА/ ТТ- instructions for breath hold     • Regular heart rate <70 bpm• Medical premedication (if it is necessary)Patient positionReference point: SNIV in the right arm:  canila: 20G / 18G(inj. rate = up to 5 ml/s)ECG far from the injector,  screen to face the acquisition console- 3 Leads: (on bone contact)64 ECG gated MSCT OF CORONARY ARTERIES AND ASCENDING AORTA « Breath in and hold your breath »5-7s2-3sPitchAPitchBReaction timeHRtimeStable windowCardiosurgery - SkopjeCardiosurgery - Skopje64 Cardiac MSCT SS Segment 45 – 70 BPM 0.625mmScan Type ScoutNum. Scout 2Start Loc. S 60.00End Loc. I 600.00kV 120mA 10Scan Type CardiacRotation Time 0.35Cardiac ModeSnap Shot Segment (Helical)Detector Coverage40.0mmHelical Thickness 0.625Gantry Tilt S 0.0FOV Cardiac LargekV 120mA EKG Modulated mATotal Exposure Time12.6Prep Group Smart PrepInterval 0.625 Cardiosurgery - SkopjeCardiosurgery - SkopjePositioning the reference image on the Smart PrepCardiosurgery - Skopje64 ECG gated MSCT OF CORONARY ARTERIES AND ASCENDING AORTAProducing timing graphCardiosurgery - Skopje64 ECG gated MSCT OF CORONARY ARTERIES AND ASCENDING AORTA Cardiosurgery - Skopje64 ECG gated MSCT OF CORONARY ARTERIES AND ASCENDING AORTA • Limitations:- Heart frequency above    65-70 bpm - arrhythmia- Uncooperative patient- Severe calcifications- obesityCardiosurgery - SkopjePga: adaptive prospective gating• Frequency 50-70 bpm• Cooperative patient• 70-80% reduction doseCardiosurgery - Skopje64 MSCT OF AORTA  WITH CARDIO PROTOCOLRetrospective ECG gating Prospective ECG gatingContinuing scanning for abdominal aorta with a single contrast applicationCardiosurgery - Skopje64 ECG gated MSCT OF CORONARY ARTERIES AND ASCENDING AORTACardiosurgery - SkopjeThe success of CT is due to:• 50% well-prepared patient• 20% previous premedication• 30% experienced, educatedradiological technologistConclusion

64 ECG gated MSCT of coronary arteries and ascending aorta - technical approach

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