cardioct 1 uc-chile oct2010
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Transcript of cardioct 1 uc-chile oct2010
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Principios FisicosCardioTC
Cristian Cabrera G.Tecnologo Medico
Radiologia y Fisica Medica
I Jornada de Tecnología Médicaen Imagenología UC
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Imagen CardioTC
Un Gran Desafio
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4 canales 16 canales 64 canales
Espesor corte 1.25 0.625 1.25 0.625Tiempo rot. 0.5 0.4 0.35Tiempo adq. 40 16-30 6-8ma 500 450-500 450-550
modul.Volumen mc. 140-150 100-120 70-80Flujo inyec. 3.0 – 3.5 4.0 – 5.0 5.0Tiempo inyec. 26~ 20-25~ 15~Volumen NaCl 40 40Config. Detect.
HQ 0.75:1 0.22:1 2.2 0.16:1 6.4
Anatomia cub. 150 150 - 300 150 - 300
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EJE Z
Orientacion Anatomica Ideal
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Eje Z??
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Trayecto Ideal Vasos Coronarios
Contraste Imagen? 4 mm.
0.7 - 1 mm.
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Trayecto Real Vasos Coronarios
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Parametros Especificos• 1. Resolucion Bajo Contraste : - Inyeccion Optima MC. - Razon adecuada Señal/ Ruido. - Filtros Cardiacos. • 2. Resolucion Espacial : - Cortes Submilimetricos (0.625mm) - Pitch / LPM congruentes. - FOV restringido a estructura. - Filtros Matematicos de Alta Frecuencia. - Nitroglicerina Spray
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Resolucion Bajo Contraste
• Inyeccion Optima medio de contraste. - Realce vasos coronarios sobre 300UH.
- Buena Opacificacion Camaras Cardiacas.
- Eliminacion o Disminucion Artefactos endurecimiento haz de radiacion.
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Resolucion Bajo Contraste
Seg.
UH.
1 ml/seg.
3 ml/seg.5 ml/seg.
130-140
160-180
35-50
220-270
15-25
350-400
5ml/seg.
5ml/seg nacl
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Resolucion Bajo Contraste
• Chequear Parametros exploracion:
- mAs
- Filtros Cardiacos
- Kv
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Resolucion Bajo Contraste
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Resolucion Bajo ContrasteFiltros Cardiacos
3 niveles de filtracion C1=bajoC2=MedioC3=Maximo
Hasta 30% Reduccion en dosis. Mantiene el nivel de ruido.
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Para pacientes delgados 100 kv podrian usarse:
•Menos Dosis (30-35%)
•Mejor resolucion de bajo contraste
Resolucion Bajo Contraste. Kv.
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Resolucion Espacial
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Resolucion Espacial
El pitch es cambiado automaticamente de acuerdo a FC.
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Resolucion Espacial
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Resolucion Espacial
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Resolucion Espacial
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Stent : Filtros standart y detail
• FOV pequeño• 0.6 / 0.3 mm• Filtro Detail
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Imagen Final??
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Frecuencia Cardiaca
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Ciclo Cardiaco.Duracion
Duracion Ciclo Cardiaco : 0.8 seg.(70 lpm).
Diastole General o Inicial(Sistole Auricular- Diastole Ventricular)
0,1 segundos
Sistole(diastole aricular-sistole ventricular)
0,3 seg.
Diastole Final0,4 seg.
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Ciclo Cardiaco
Diastole
Fin Diastole
Sistole
Fin Sistole
0,5 seg 0,3 seg
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Parametros Especificos
• 3. Resolucion Temporal : Medida del largo de tiempo dentro de una imagen.
• Que es la Resolucion Temporal de la imagen en TC?
Si definimos la resolucion temporal en mseg. , podemos concluir que la resolucion temporal maxima para un equipo VCT es de 350 mseg., con reconstruccion de imagen completa ( 360º).
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Resolucion Temporal
• Tiempo Rotacion Tubo Rayos X.
• Frecuencia Cardiaca.
• Pitch
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Avances Resolucion Temporal
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Reconstruccion Imagen 360º
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Como podemos disminuir mas la Resolucion Temporal?
• Tecnica Half Scan Recon
• Tecnica Gatillado Cardiaco
• Tecnicas de Snaphot
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Tecnica Half Scan Recon
• Usamos una exploracion de solamente 180º para generar una imagen.
• Por lo tanto la RT disminuye a la mitad(175 mseg.).
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Half Scan Recon
No Emision RxEmision Rx
0º
240º
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CardioTC Gatillado
• Que es el gatillado cardiaco?
- Es una tecnica donde la reconstruccion de la imagen esta centrada en un % de fase del ciclo cardiaco R-R.
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Electrocardiograma
P
Onda P
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ElectrocardiogramaIntervalo P-R
P
R
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Haz de His (Ramas Derechas)
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Haz de His (Ramas Izquierdas)
Complejo QRS
R
Q S
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Segmento S-T
S
T
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Onda T
T
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Gatillado Cardiaco
100%
75%
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Gatillado Cardiaco• Gatillado Prospectivo:
Adquisicion Secuencial Menor Dosis Radiacion Sin Interpolacion Datos
• Gatillado Retrospectivo:
Adquisicion Volumetrica Sobreproyeccion Datos en Interpolacion. Capacidad Multiples fases de reconstruccion. Posibilidad Estudios Anatomicos y Fisiologicos. Aumento Dosis Radiacion.
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Gatillado Prospectivo
+ + n
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Gatillado Retrospectivo
75%40%15%
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Frecuencia CardiacaPunto Clave
• Lo ideal es: - Frecuencia Cardiaca bajo 60-65 lpm.
- Frecuencia Estable (variacion < a 10% entre cada medicion de lpm).
- Hiperventilacion.
- Uso de Betabloqueadores.
- Lectura Adecuada ECG sincronizado.
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Frecuencia Cardiaca
60 lpm
1 seg. FC baja estable
FC Inestable
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Frecuencia Cardiaca Elevada
• Snapshot Segment
• Snapshot Burst
• Snapshot Burst Plus
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Snapshot Segment• Resolucion Temporal VCT:
175 mseg.• Rango Frecuencia Cardiaca:
30-65 lpm.
Detector 1Detector 2
Detector 3Detector 4
0º
240º
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Snapshot Burst• Reconstruccion Multisector utilizando 2 ciclos cardiacos adyacentes.• Resolucion Temporal VCT 87 mseg.• Rango Frecuencia Cardiaca: 65 - 85 lpm.
Detector 1Detector 2
Detector 3Detector 4
0º
240º
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Snapshot Burst Plus• Reconstruccion Multisector utilizando 4 ciclos cardiacos adyacentes.• Resolucion Temporal VCT 44 mseg.• Rango Frecuencia Cardiaca: 85-114 lpm.
Detector 1Detector 2
Detector 3Detector 4
0º
240º
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Factor Pitch/ Frecuencia CardiacaRango FC(Lpm)
Rotacion Tubo (seg)
Modo expl./recon.
Pitch
30-40 0.35 s.Segment 0.1641-49 0.35 s.Segment 0.1850-57 0.35 s. Segment 0.258-65 0.35 s. Segment 0.2266-74 0.35 s. Burst 0.2475-85 0.35 s. Burst 0.286-95 0.35 s. Burst P. 0.2296-113 0.35 s. Burst P. 0.24114 + 0.35 s. Burst P. 0.2
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Hiperventilacion
Hiperventilacion
14-15 seg
FHV
2-3 seg
Tiempo Reaccion
5-7 seg
Estabilidad Frecuencia Ventilacion
FC
Tiempo
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Imagen Anatomica Final
Fin del Estudio?
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Funcion Cardiaca en CardioTC
75%40%15% 0% 100%
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Funcion Cardiaca en CardioTC
• Formulas de Analisis Ventricular Fraccion Eyeccion (EF) Espesor Pared (WT) Gasto Cardiaco (CO) Volumen de Stroke (SV) Desplazamiento Cardiaco (CI) Volumen Diastolico Final (EDV) Volumen Sistolico Final (ESV) Indice Volumetrico de Stroke (SVI)
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Fraccion Eyeccion
• EF = (SV / EDV) x 100 Expresado normalmente como porcentaje. Medicion de funcion ventricular izq., mas aceptada. Rango normal : 55 to 80% (promedio 67%) en
condiciones de reposo.
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Espesor de Pared
Medicion directa con CardioIQ
• Medicion Ventricular (mm)
• Promedio pared ventricular izq. = 10 mm
• Promedio pared ventricular der. = 3 mm
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Volumen Ventricular
Puede ser medido por CardioIQ. Medido en mililitros (ml).
• Volumen Diastolico Final (EDV)
• Volumen Sistolico Final (ESV)
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Volumen de Stroke
VS = LVEDV – LVESV
• VS es la cantidad de sangre eyectada por el ventriculo izquierdo con cada contraccion.
• VS muestra la performance ventricular sin la influencia del latido cardiaco.
• Rango normal 60-100 ml por latido.
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Indice Volumetrico de Stroke
SVI = SV / BSA
• SV es la cantidad de sangre eyectada por el ventriculo izquierdo con cada contraccion.
• Este Indice toma en cuenta el tamano del cuerpo.
• Medicion mas precisa.• Rango Normal 33-47 ml/latidos/m2
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Gasto Cardiaco
CO = (BPM) x SV
• Normalmente expresado como lts/min.
• Sangre bombeada por el ventriculo izq.
• Adulto normal: 5.6 litros.
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Medicion Funcion Sistolica
Fin Diastole Fin Sistole
Fraccion Acortamiento/%) = Diametro ED –Diametro ES
Diametro EDRango Normal: 18 – 42 %
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Conclusion• La imagen de CardioTC requiere mas que
nunca la utilizacion de los 3 parametros de Resolucion.
• Una adecuada preparacion y comunicación con el paciente es fundamental.
• Manejar todas las herramientas disponibles en el equipo para obtener una imagen diagnostica optima.
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