Angiographic

Views&
Anatomy
Dr. Mohammad Gouda
Lecturer of Cardiology
Generally..
Main coronary trunks can be considered
to lie in one of two orthogonal planes:
1. Anterior descending and posterior
descending coronary arteries lie in the
plane of IVS
2. RCA& LCX lie in the plane of AV valves
3. In the 60 LAO projection, one is looking
down the plane of IVS, with the plane of AV
valves seen en face
4. In 30 RAO projection, one is looking down
the plane of AV valves, with plane of IVS
seen en face
General Roles
1. LCX goes with intensifier and LAD goes in the
opposite direction. In other words, moving the
intensifier leftward to LAO will project LCX to the
left on the XR picture and LAD to the right
2. Cranial angulation will elevate LCX up and pull
LAD down. It is the reverse with caudal
angulation. The same rule is applied to the
diaphragm and the spine.
3. In order to straighten a tortuous coronary segment,
the image intensifier should be moved to an angle
with more or less 90 opposite to the present one
Left System
Practically
WHERE IS THE LAD?????
HOW TO KNOW IT????
SO,
Is LAD is to Rt or Lt to LCX?
If LAD is to Rt to LCXthis is PA Or
LAO
If LAD is to Lt to LCXthis is PA Or
RAO
Where is the spine, LM on line or curved, angle
bw(LAD-LCX)?
Cranial Or caudalDiaphragm, Px Or Distal bed well visualized??
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LAO views
By placing the left hand
fingers over the clenched
right fist, the index finger
becomes LAD and runs over
the knuckles, which
represent the anterior IV
groove
The middle finger is spread,
lying on the finger joints,
and represents LCX
The thumb runs horizontal
to the wrist joint and
represents the initial course
of RCA
cranial and
caudal angulations
In cranial angulation, a
downward tilt of LAO view,
exaggerating the left main
segment but keeping the
relationship between LAD and
CFX almost the same
Caudal angulation: views
coronaries from underneath,
tipping the LAO view upward
and producing a branching
appearance some call the
spider view.
RAO projections
RAO, position of the fingers
(LAD/CFX) changes orientation such
that the LAD is now on the left, and
the CFX is in the middle or more
rightward than in the LAO view
RAO with caudal angulation tips the
CFX downward, separating it more
from the LAD.
RAO with cranial angulation, the CFX
is tipped upward, foreshortened, and
overlapped with the LAD. Cranial
views are best used to see the LAD
and diagonals, while caudal views are
best to see the CFX and LM segments
Take a breath.
LAO-
caudal
view
Spider
view
1
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2- LCA lateral view
LAO-cranial
view
demonstrates
mid and
distal LAD
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RAO caudal view,
LCX is well
elongated and so
fully
exposed.
RAO-caudal view assesses
LCx and Oms
RAO-caudal projection
(0 to 10 RAO and 15 to
20 caudal) our initial
view of choice in studying
unstable patients, because
it provides an excellent
view of the left main
bifurcation, proximal
LAD, and proximal to
middle LCX
RAO caudal view, LCX is well
elongated and so fully
exposed.
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AP cranial view
LAO cranial view
RAO caudal view
RCA
L-Shaped
RCA.Shape
C-shaped
RAO LAO PA Lateral
RCA Ostium & mid
portion of the RCA
with separation of
the RCA and its RV
branches
RV Marginal branch & Spine
Demonstrates
RCA and
origin of PDA
and PL
branches
Mid RCA +
Px, Mid &
Distal
termination of
PDA.
Termination of
RCA, including
the bifurcation
of RCA and
PDA (crux)
and PL
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RAO view of RCA. In this view,
the guide is truly coaxial, so the tip
of the guide will be seen headon as
a circle.
RAO view of RCA anomaly with the ostium in the
anterior position. In this view, if the guide is truly
coaxial, then the tip of the guide should be seen
head-on as a circle. As the location of the ostium in
this case is abnormal, so the tip of the guide points
to the left.
LAO view of RCA. In this view, RCA is
like a letter C. To focus on the ostial
segment, a caudal angulation is needed.
A cranial angulation would help to
visualize the bifurcation, origin, and
course of PDA.
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Thanks
Dr Mohammad Gouda