CREATION OF AN
OPTIMAL ANGIO
SUITE
A. CHATZIOANNOU
DEPARTMENT LAYOUT
•Total 65 m2 not including
the X ray control
•Large lead lined doors to allow
admission of bed with ancillary
equipment
•Ceiling 3,5 -4 m with additional
space above to allow mechanical
access
MAIN FEATURES
Fluoroscopy unit
Dirty utility space adjoining
the examination space
Scrub sink with hot and cold
water
Surveillance X ray control
(10 m2)
Storage space, apron rack
and shelves for all
equipment
Surgical ceiling mounted
lights
Patient preparation space/room
Fluoroscopy history
Popular Science: July 1939
Fluoroscopy unit
Motion features
•C or U arm which can rotate in
axial and sagittal planes
•Angles of rotation must be
displayed on the monitor
•Ability to vary source detector
distance
•Combination of fluoroscopy arm
and table movement should make
imaging of the whole body
possible
•Manual override and locking
should be possible
Fluoroscopy unit
Table features
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Support at least 140 kg
of weight
Tilting capability both in
craniocaudal and lateral
direction
Ability to move away
from C-arm in case of
emergency
Additional ( foot and
hand) controls to use by
the radiographer
Fluoroscopy unit
Imaging features
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Image intensifier with large
field of view (FOV)
Digital subtraction and
acquisition (DSA)
Pulsed fluoroscopy for dose
reduction
Variety of frame rates
Various collimators
Filters to reduce skin dose
Road mapping and land
marking
Last image hold and frame
grab
Fluoroscopy unit
Image quality
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The image quality mainly depends on the flat
panel (image intensifier) and the processing
system
Image quality of fixed systems >> quality of
mobile systems (difference in focal spot and
tissue penetration)
Fluoroscopy unit
Image quality – Image Intensifier
The image intensifier determines the Field of View
(FOV). FOV is of great importance especially in aortic
interventions. It depends on the size of the image
intensifier.
The image intensifier should have:
- large FOV (36 -41 cm)
- three modes of magnification
-spatial resolution at least 2.5 line pairs/mm in
the 36-cm FOV, 3.3 line pairs/mm in the 23cm FOV, and 4.6 line pairs/mm in the 15-cm
FOV
- contrast ratio at least 20:1
- automatic brightness control
Fluoroscopy unit
Image quality – Processing system
Digital Subtraction and Acquisition
•1024x1024 image matrix (ability to
display compressed images
on a 512x512 matrix)
•Display at least five frames per
second in the 1024x1024
mode.
•Road-mapping (helpful during
percutaneous transluminal angioplasty,
with or without stent placement, and
during passage of guidewires through
tortuous vessels)
•Measurement of vessel diameter
Fluoroscopy unit
Heat capacity
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Overheating is rare in
modern equipment
due to the presence of
excellent cooling
systems (oil and water
based)
Fluoroscopy unit
Radiation exposure
•It varies greatly between
different procedures
•It is dependent on multiple
factors. One factor is the
fluoroscopy unit itself.
•Radiation exposure is
higher using portable Carms than fixed systems
Don’t forget
Important issues of a modern
angiosuite
Sterility issues
 Ability to convert
 Anaesthesia
 Ergonomics
 Personnel
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Important issues in a modern angiosuite
Sterility issues
Angiographic and interventional procedures should be
performed in strictly aseptic conditions
 Primary and secondary operators should wear sterile
gowns and gloves as well as surgical caps and masks.
 Sterile, impervious barriers should be available to
cover any part of the equipment that may contaminate
the field
 Appropriate receptacles for contaminated items should
be readily available
 OR sterility > Angiosuite sterility
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Important issues in a modern
angiosuite
Ability to convert
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Majority of endovascular procedures without
major intra-operative complications
In case of conversion to open surgery, the lack
of adequate lightning, suction, surgical and
anaesthetic equipment and room for surgical
instruments, and the extra personnel can make
even small procedures challenging
Important issues in a modern
angiosuite
Anesthesia
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Although endovascular
procedures are minimally
invasive,adequate monitoring of
the cardiopulmonary system is
essential in certain procedures
(eg carotid stenting)
The presence of an
anesthesiologist, a specialized
nurse and all anesthetic
equipment seem to be of major
importance
Important issues in a modern
angiosuite
Ergonomics
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Poor ergonomics is one of the major drawbacks
of mobile systems
Ideally, a monitor should be placed just below
eye level (10-15 degrees angle)
Monitors on bothsides of the table
Ceiling-fixed monitors perform a great range of
positions,without claiming space on the floor.
Adjustment of the position of these monitors is
easier
Important issues in a modern
angiosuite
Personnel
Specially trained personnel
• Physicians should spend enough time doing
procedures to fulfill the obligations of the angio suite
and should perform a sufficient number of procedures
to maintain proficiency and competence.
• All personnel should have knowledge about catheter
techniques and the various materials that are used
such as sheaths, guide wires, catheters and stentgrafts
• All personnel should have knowledge about radiation
safety measures