BS RADTECH BATCH 2025 | 9:00 AM – 12:00 PM, WEDNESDAY.

III. DIGITAL SUBTRACTION • DSA – focus on blood vessels

ANGIOGRAPHY o Digitally removed
ANGIO surrounding bones and
tissues to visualize
means blood vessel and angiography is (opacify) vessels injected
the radiological study of blood vessel with contrast.
in the body after the introduction of
iodinated contrast media.

SUBTRACTION

It is simply a technique by which bone

structures images are subtracted or
cancelled out from a film of bones plus
opacified vessels, leaving an
unobscured image of the vessels. HISTORY
• Angio – vessel The Portuguese neurologist Egas
• Graphy - study Moniz, (Nobel Prize winner 1949), in
1927developed the technique of
WHAT DO YOU MEAN BY DSA? contrast x-ray cerebral angiography to
diagnose diseases, such as tumors and
Digital subtraction angiography (DSA)
arteriovenous malformations.
is a technique commonly used to
optimally visualize blood vessels. The idea of subtraction images was
first proposed by the Dutch
During DSA, bones and other soft
radiologist Ziedses des Plantes in the
tissue are “subtracted” from the
1935, when he was able to produce
fluoroscopic image, leaving only an
subtracted images using plain films.
image of contrast-filled blood vessels.
With the introduction of the Seldinger
WHAT DO YOU MEAN BY DSA?
technique in 1953, the procedure
Digital subtraction angiography (DSA) became safer as no sharp devices need
is the acquisition of digital to remain inside the vascular lumen.
fluoroscopic images combined with
• Uses plain film
injection of contrast material and real-
• Takes images with plain film and
time subtraction of pre- and post-
vessels with contrast
contrast images to perform
• Compare two images
angiography.
HISTORICAL DEVELOPMENT

CONVENTIONAL SUBTRACTION
TECHNIQUE

• Photographic method used to

eliminate unwanted images.
• No addition of information; only
purpose to make diagnostically
• Most common in diagnostic
important information to see.
o Aneurysm
• First described by a Dutch
o Pseudoaneurysm
radiologist, Zeides des Plantes,
o Any arterial injury
1935.
• Therapeutic:
3 conditions: o Surgical
• SCOUT FILM
• ANGIOGRAM FILM-
CONTRAST
• NO MOTION OF HEAD
o Even in digital

• Poor kidney function

o Poor renal reserve
o Deranged coagulogram
o Reason: The CM will just
stay in the patient’s
kidney and later be
TOXIC
o Creatinine level –
determine if proper
functioning kidney
▪ No definite level,
depending on the
institution
 APPLICATION OF DSA WHY DIGITALIZATION?
DIAGNOSTIC VASCULAR • For all the image processing and
CONDITIONS manipulations done in DSA,
DSA is used to diagnose conditions computer is must.
such as aneurysm, artery stenosis and • Because computer can handle
vascular malformations. data only in bit format,
conversion is necessary for
GUIDING INTERVENTIONS subtraction techniques to be
applied by computer.
DSA provides real-time imaging to
• Also, easy storage and retrieval
guide surgical and interventional
is possible.
radiology procedures for treating
• Basic operation: Central control
vascular tissues.
computer is in charge of all the
EVALUATING TUMOR BLOOD other components of the image
SUPPLY processor.
• Suppose we tell the computer to
DSA helps in assessing the blood
run a series of a certain number
supply to tumors, aiding in treatment
of exposures and to store each
planning for oncological interventions.
image of the series in the digital
form for later use.
• Computer uses first image as a
PROCESSES INVOLVED IN DSA mask. Display each subsequent
I PRE-PROCESSING: Digitalization: images in subtracted form.
Analog to digital conversion. • We set the exposure techniques
II PROCESSING: Subtraction on generator and instruct the
Techniques computer to begin.
• It sets up the digitizer to
• Temporal Subtraction convert entire TV frame into
o Mask Mode Subtraction digital image and starts the
o Time interval difference digitizer at appropriate time.
Subtraction • Meanwhile computer has
• Dual Energy Subtraction instructed what to do with first
• Hybrid Subtraction digitized image which is simply
III. POST-PROCESSING: to place the image in appropriate
Manipulations to enhance visibility. form and to store it in a
particular block of image
IV. INFORMATION EXTRACTION memory.
 • The computer tells the digital • A digital image is normally
disc where that block is located composed of a two-dimensional
in image memory, how big the (square) matrix of pixels.
image is, and when to start • The matrix size of an image is
storing the image. used to describe the number of
pixels in each row and column of
ANALOG TO DIGITAL
the image. As matrix size
CONVERSION
decreases, larger pixels are
• One of the most important step required to maintain a constant
• Analog information is any field of view. Less resolution.
information represented in • Binary number system: This
continuous rather than discrete system is used by computer to
fashion. store image data in the form of
• Digital information is any pixel. Uses o and 1 to store bits.
information that is represented
in discrete units.
• Video images are in form of lines
with each point online
represented as voltage
• Digitalization involves
conversion of all the points of
voltage into pixels of discrete
value.

MATRIX SIZE AND PIXEL

PROCESSING IN DSA
• Pixel is smallest element of TYPES OF SUBTRACTION
digital image.
• The size of a pixel determines 1. MASK MODE SUBTRACTION
the smallest detail visible on the • Most widely used process of
image.
subtraction.
 • In which temporal subtraction is 2. TIME INTERVAL DIFFERENCE
done. Mask mode subtraction. SUBTRACTION
• It involves initial acquisition of a • Another mode of temporal
frame of region of interest. subtraction where a consecutive
• Then a second image is taken and previous frame is subtracted
stored as mask image. from current frame (e.g. frame
• This mask image is subtracted 1 from frame 2, frame 2 from
from subsequently acquired frame 3 and so on).
images and show only contrast • This technique is very useful in
filled structures. cardiac imaging where there is
rapid motion.

• Initial acquisition of a frame of

• Time interval follows for
ROI
subtraction.
DISADVANTAGE 3.DUAL ENERGY SUBTRACTION
• If any movement occurs after • Another technique in which the
acquisition of mask image region of interest is exposed to
misregistration occurs in the higher KV (120 to 130kV) and
subtracted images. lower kV (70kV) at very short
• This can be overcome to some interval (about 50ms).
extent by pixel shifting.
 • Then, the higher kV image is • But advantage is that minor
subtracted from lower KV image motion effects can be tolerated.
to produce the image. Less exposure time.
• As both images are taken at
same patient position as against
mask subtraction technique.
4. HYBRID SUBTRACTION
• Is a combination of dual
energy and temporal
subtraction.
• Advantage - eliminates
• Exposed to a variety of kVp effect of patient motion.
• First image has low kVp
• Next image will have a higher
kVp

• Temporal + Dual Energy

Subtraction

TECHNIQUES USED IN DSA

PROBLEMS OF DUAL ENERGY
• Road map technique
SUBTRACTION
• Fluoroscopy fade technique
• More complex x-ray machine is • Dynamic 3d road mapping
needed to rapidly switch kVp and technique
mA.
• Due to difference in beam 1. ROAD MAP TECHNIQUE
hardening in soft tissue and
bone improper subtraction
results (Higher kVp x ray beams
will have different beam
hardening than lower energy Not
a problem in mask subtraction
because only one x ray beam
energy is applied.)
 • In which static fluroscopic 2. FLUOROSCOPY FADE
image is subtracted from TECHNIQUE
densely opacified vessel.
• Here, a short contrast run of • In which a reference DSA image
vessel is done under fluoroscopy is overlaid on the real time
to select the frame with fluoroscopic image.
maximum opacification of the NOTES
vessel as the road map mask.
• First image: Spot image
• Then subsequent live
fluoroscopic image is subtracted o Static image
from the road map mask for 3. DYNAMIC 3D ROAD MAPPING
visualization of the vessel and
the catheter/guide wire. • New development allows
• This technique is very useful in protection of 3D reconstructed
placement of catheters and vessel on live 2D fluoroscopic.
guidewires in complex and small
Peripheral DSA
vessels.
• Can be performed with single
NOTES contrast injection using stepping
technique.
• First image with CM
• Subtract from fluoroscopic Two types
image
1) Stepping table technique
• Under therapeutic DSA
o Catheter 2) Stepping gantry method
o Guidewires
STEPPING TABLE TECHNIQUE
• Long procedure
o Flush out CM before • In this table moves into three
taking another image stations with x-ray tubes and
LIMITATIONS detector remaining fixed.
• Can be moved
• Motion after road map o Trendelenburg
acquisition may affect o Left and right
subsequent intervention. • Source and detector do not
move.
STEPPING GANTRY METHOD EQUIPMENT AND TECHNIQUES
IN INTERVENTIONAL RADIOLOGY
• In this method, the tube
detector or image intensifier
moves keeping the table fixed. WHAT IS VASCULAR AND
• Source and detector (image INTERVENTIONAL RADIOLOGY
intensifier) moves Interventional radiology is a medical
• Px table is fixed subspecialty of radiology utilizing
In both methods pre-contrast images minimally invasive image guided
are acquired at different stations procedures to diagnose and treat
and stored as mask image. diseases in nearly every organ system.

Subsequently matching post contrast Concept: is to diagnose and treat

injection images are taken at same patients using the least invasive
position and subtracted from the techniques currently available to
corresponding mask image to produce minimize risk to the patient and
clear image of peripheral arteries.
improve health outcomes
BENEFITS
Have less risk less pain and less
• Significantly reduce use of recovery time in comparison surgery.
contrast.
• Reduce examination time. HISTORY
1923
DISADVANTAGE
- Angiography was first
• Increased chances of movement
between preconstrast and post successively used for the human
contrast images body.
1953
An important advancement in digital
fluoroscopy is rotational angiography. - Swedish Doctor Sven Ivan
Seldinger pioneered the
• New advancement
seldinger technique which laid
In this x ray tube-detector system down the foundation of
rotates through visually 90 degrees to
interventional radiology.
180 degrees while acquiring continuous
1963
images.
- Charles Dotter first proposed
the idea of interventional
radiology.
1964 - method for catheterization of
vessels
- Charles Dotter opened a new
- develop in 1950 still popular
era of percutaneous
today
angioplasty through accidental
- percutaneous (through the skin)
operation, marking the
technique for arterial and
formation of interventional
venous access
radiology.
- 3 vessels considered.
o Femoral – preferred site
Currently it is applied in the diagnosis
for arterial (size +
and treatment of many diseases of the
accessibility)
internal organs like the pancreas, liver
o Brachial
kidney, spinal cord, fallopian tubes,
o Axillary
esophagus and other organs.

PREREQUISITE
CHARLES T. DOTTER M.D (1920-
- Selection based on strong pulse
1985)
/ absence of disease.
- Interventional radiologist
- Site cleaned, area draped, local
- Pioneer in the minimally invasive
given
procedures (catheterization)
- Developed continuous Xray
STEP BY STEP
angiocardiography.
1. Insertion of needle
- Performed first angioplasty
2. Placement of needle in lumen
procedure in 1964
3. Insertion wire thru needle,
advance 10 cm
MICROPUNCTURE KIT
4. Removal of needle – guide wire in
- 21-gauge access needle
position
- 5 Fr Sheath and Dilator
5. Threading of catheter to area
- 0.018 Guide wire
of interest – fluoro used
- Generally used for access to
6. Removal of guide wire -
small vessels
catheter remains in place
- i.e radial, tibial, etc.

Cut down – minor surgical procedure to

SELDINGER TECHNIQUE
expose vessel of interest.
- Sven Ivan Seldinger Swedish
Radiologist – 1921-1998
Trans-lumbar - patient prone, long BASIC CONVERSION AND
needle passed thru T12 – L2 into aorta MEASUREMENTS
Needle diameter is measured in
CANNULAS gauges.
- The lower the gauge, the larger
the needle.

Catheter and sheath diameters are

measured in French (F) units.
- 1F = 1/3 mm
- 1F = 0.013 inch

Simple 18-gauge angiographic puncture Wire Diameter is measured in inches.

needle – one piece open needle with a - 0.018 and 0.035 wires are 0.018
sharp beveled top. and 0.035 inch in diameter,
respectively.

ACCESS NEEDLES AND BIOPSY

NEEDLES
Access needles are used to enter
blood vessels, organ or collections.
- 19 gauge accepts 0.035 inch
guide wire
- 21 gauge accepts 0.018 inch
guide wire

NEEDLES
Guidewire is introduced directly
through the needle once the tip is fully SINGLE PART NEEDLES
within the bleeding vessel lumen. This
style of needle can be used for both
arterial and venous punctures.
 - Only requires puncture of - Soft touch spring loaded biopsy
anterior wall. needles.
- Vital that pulsating blood flow - Westcott biopsy needles
from the hub before introducing - Disposable automatic core
the guidewire. biopsy needles.

TWO PARTS NEEDLES

- Are very simple to use but

require a double wall puncture,
i.e. both the front and back wall
of the artery
- The sharp central trochar is
removed and the outer metal
cannula slowly withdrawn until
there is a good blood flow
- Has an inner trochar FNAC

BIOPSY NEEDLES

- Designed to remove tissue for

pathology or microbiology
analysis
- FINE NEEDLE ASPIRATION
o 20-25 gauge
o Sample of cells
- CORE NEEDLE BIOPSY
o 14-20 gauge
o Sample of tissue - The lesion is pierced with a thin
(gauge 21-25) needle.
Biopsy Needles - The plunger is withdrawn.
- Coaxial disposable guide Without exiting the lesion and
- Disposable biopsy needles without releasing the plunger
- PAN aspiration needle
 the needle in moved in an out in BIOPSY GUN
different directions.
- The needle is withdrawn and the
material aspirated smeared on
to a slide, stained and examined.
- FNAC NEEDLES
o Chiba
o Franseen
o Westcott
o Greene
o Spinal
- Traditional fine needle
aspiration biopsy needles which
WIRES
harvest cells for cytological
Wires have three main properties:
evaluation.
- Diameter
- Stiffness
CORE NEEDLE BIOPSY
- Hydrophilic or nonhydrophilic
- The needle is inserted into the composition
mass
- Outer sheath is fired There are three basic types of wire
- Needle is withdrawn with a core categorized according to the above
of tissue his in processed as any properties:
other biopsy would.
ACCESS WIRES
SEMIAUTOMATIC BIOPSY NEEDLE
- Simple short wire
- Used for access and often
quickly exchanged.

MANEUVER WIRES

- Often floppier body

- Tip is often curved, floppy and
hydrophilic.
- Commonly used to sub select
vessels.
RAIL WIRES

- Stiff
 - Provides a stable platform for
exchanges, balloons, stents and
maintaining access

HYDROPHILIC WIRES

Useful in a fluid environment and when

a narrow area must be traversed and
less resistance is desired (eg. In small
vessels, in the pylorus for
percutaneous gastrostomy) ▪ GLIDEWIRE
o Commonly used maneuver
Very slippery when wet and sticky when wire
dry (flush them and keep them wet) o Torque device can be used
to help maneuver the wire
0.018 inch o Black
▪ STIFF GLIDE
o Commonly used maneuver
or ral wire
o As stiff as amplatz wire
o Comes in a blue reel which
differentiates it from
regular glidewire
o Black
▪ ROADRUNNER
o Rail wire
o Very stiff
▪ GLIDEWIRE o Floppy tip
o Maneuver wire with o White
curved or straight tip
▪ V18 NONHYDROPHILIC WIRES
o Rail wire; very stiff; • Easier to grip
floppy end but not curved; • Do not become sticky
gray • May offer more resistance when
0.035inch transversing narrow areas.

0.018
 o Floppy portion of the tip
is stiffer than bentson
wire
o Can be used to maneuver
or as rail wire
o green
▪ Rosen
o Still curved tip
o Green
o J wire is a genetic term
NItrex
for wires with this curved
o Not curved but used as a
tip and there are many
maneuver wire
types
o Very flexible
o A j wire is a standard
o Gold
component of central line
Cope
kits
▪ Very commonly used
▪ Amplatz
accessed wire
o Floppy tip
▪ Comes in a micropuncture
o Very stiff
kit
o Rail wire
▪ Gray
o Blue
0.035 inch
▪ Lunderquist
o Incredibly stiff
o Rail wire
o Gray
▪ Meier
o Somewhat floppy tip
o Very stiff
o Rail wire
o Green and gold

▪ Bentson GUIDE WIRES

o Very floppy tip
o Could be used to Are available in a number of
maneuver or as a rail wire thicknesses, lengths , tip
o Relatively stiff configurations, stiffness and materials
o Green of construction.
▪ New Yorker
Too big will jam , usually at the tip of o 0.038 inches with introduce
the catheter device (arrow) to
straighten guide wire
If a guide wire is much smaller than the during insertion into needle
end hole of the catheter or device, hub
there will be a gap between the guide - Angled High- torque
wire and catheter that can cause o 0.035 inch
vessel injury or prevent smooth - Angled Hydrophilic – Coated
movement over the guidewire. o 0.038 inch nitinol wire with
pinvise (curve arrow) for
Thickness measure in one hundredths fine control
of an inch: 0.038 iches, 0.035 inches, - Platinum – Tipped Microwire
0.014 inches. o 0.018 inch

PINVISE
COMMON GUIDEWIRES Very useful for gripping the wire for
torque control particularly when using
hydrophilic wires.

There are different sizes for 0.14 or

0.35 wires.

- Straight
o 0.038 inches
- J – tipped CATHETERS
Measure in French Size who designed it or the intensed
use.
One French size is equivalent to 0.33
of a mm COMMON CATHETER SHAPE

Modern catheters are made of plastic

also have a slippery coating to reduce
resistance and improve
maneuverability.

Diagnostic catheters have multiple

side holes in addition to an end hole to
allow rapid injection of large volumes
of contrast medium.

Flow rates are determined by the FLUSH CATHETERS

lumen size, number of side holes ,
pressure of injection and length Allow high flow injections into the
aorta or inferior vena cava.
• 3f 6-8 mls/second
Uniform dispersal of contrast media
• 4f 16-18 mls/second via multiple side holes

• 5f 20-25 mls/second The tip is usually designed to help

center the shaft in the vessel and
STRUCTURE OF CATHETER prevent engagement and injection into
- Catheter outer size is describe branch vessels
in French gauge (3F = 1mm)
- Diameter of the end hole is SELECTIVE CATHETERS
described in hundredths of an Have rotational stiffness to seek a
inch vessel orifice, but with enough
- The length of the catheter is flexibility to pass the catheter far into
described in centimeters the vessel
(usually between 65 and 100 cm)
- The shape of the tip is named Shaped in a particular way to seek
for either something the intended vessel ostium
catheter looks like the person
PIGTAIL / OMNIFLUSH ▪ similar uses to those of SOS and
mikaelson ; decreases curve
▪ pig tail end allows easier advancement over
▪ multiple side holes on the a wire.
straight and curved portions of
the catheter
▪ used for venography and
arteriography
GLIDECATH

▪ hydrophilic
▪ many tip types
▪ commonly a 45 angle
▪ very commonly used
MICROCATHETER

▪ used as a delivery catheter

▪ regade is 3F and can fit inside a
5 F catheter
▪ used with a microwire
SIMMONS

▪ reverse curve
▪ very commonly used for celiac
▪ superior or inferior mesenteric
and renal arteries
▪ sim 1-3 catheters have
different lengths of the reverse
curve component with sim 3
being the longest
SOS

▪ reverse curve
▪ curved tip is different from
simmons catheter but has many
of the same uses

COBRA
 Typically 2F – 3F in diameter, with
SELECTIVE CATHETER SHAPE 0.010 – 0.027 inch inner lumens
▪ ANGLED CATHETER
o When angle of axis of Designed to reach far beyond standard
branch vessel from aortic catheters in small or tortous vessels
axis is low
▪ CURVED CATHETER
o When angle of axis of
branch vessel is between
60 and 120 degrees
▪ RECURVED CATHETER
o When angle of axis of
branch vessel from aorta
is great

COMPLEX CATHETERS
Shape must be reformed inside the
body after insertion over guide wire

Any catheter will resume its original

shape, provided there is sufficient
space within the vessel lumen and
memory in the catheter material

Some catheters shapes cannot re form Wide range of characteristics:

spontaneously in a blood vessel, ▪ Stiffness
particularly the larger recurved ▪ Braiding
designs like the simmons. ▪ Flow rates
▪ Hydrophilic coatings
MICRO CATHETERS
Commonly used in embolization of
intracranial aneurysm:
Small catheters that are specially ▪ Echelon 90 deg
designed to fit coaxially within the ▪ Exelcior SL 10
lumen of a standard angiographic
catheter are termed micro catheters
 SHEATHS
Consist of an inner dilater and outer
sheath with an haemostatic valve

They vary from 4-30 french and 11-

GUIDING CATHETERS 30 cm in length
Designed to make selective
catheterization and interventions They are introduced as for catheters
easier. over the wire and then the inner
dilater is then removed and the side
These catheters can be used in some port flushed within heparinized saline
situations to help position and stabilize regularly to prevent thrombus
standard catheters formation.

These catheters can be used in some

situations to help position and stabilize
standard catheters

They are used in circumstances in

which standard catheters are difficult
to position selectively

VASCULAR SHEATHS
These are large lumen catheters that
are placed proximal to give stable
position for placement of instruments
like micro catheters, coils, stents
within target lesion
Placed over the wire through the Y CONNECTOR
access site, open at one end and capped
with a hemostatic valve at the other.
Walls are non tapered – beveled to
closely match the dilator size so as to
give a smooth transition between
sheath a dilator. Available in various
lengths and diameters. Diameter of a
sheath is measured in “French” . These are connected on the hub of
Sheath selection is based on intended guiding catheters for hemostasis and
purpose. for placement of microcatheters as
well as allow a continuous infusion of
Short 4/5 Fr sheaths for diagnostic heparinized salin from the side port
purposes long sheaths with larger
diameters for interventions TUOHY BURST
BALKIN’S CROSS OVER SHEATH This is a Y shaped device which has
Placed on contralateral side after hemostatic valve on one limb and a tap
crossing over the aortic bifurcation. on the other. This allows smaller wires
or catheters to be used in larger
Facilities easy access and treatment to catheters.
lesions in the iliac /SFA and high tibial i.e. 0.08 wire in a 0.35 lumen as well as
arteries. allowing simultaneous flushing or
contrast injection.

REMOVABLE HOMEOSTATIC
VALVE
Useful for converting guiding
catheters effectively into sheaths and
during cloth aspiration.
The sheath can be removed in order to
get all of the clotting out of the
catheters.

STENTS
Small flexible tube made of plastic or
wire mesh, used to treat a variety of
medical conditions

BALLOON EXPANDABLE

Original stents, useful for flush

common iliac lesions and accurate
placement and fully expanding
strentgrafts.
BS RADTECH BATCH 2025 | 9:00 AM – 12:00 PM, WEDNESDAY.

TEST I. DIGITAL SUBTRACTION performing digital subtraction

ANGIOGRAPHY angiography.
IDENTIFICATION ANEURYSM, PSEUDOANEURYSM

1. Is the acquisition of digital 7-8: The portuguese neurologist EGAS

fluoroscopic images combined with MONIZ developed the technique of
injection of contrast material and real- contrast xray cerebral angiography to
time subtraction of pre- and post- diagnose diseases in year 1927
contrast images to perform
9. This is simply a technique by which
angiography.
bone structures images are subtracted
DIGITAL SUBTRACTION or canceled out from a film of bones
ANGIOGRAPHY plus opacified vessels, leaving an
unobscured image of the vessel.
2-3: The idea of subtraction images
was first proposed by ZIEDSES DES SUBTRACTION
PLANTES in year 1935, when he was
10. The radiological study of blood
able to produce subtracted images
vessels in the body after the
using plain films
introduction of iodinated contrast
4. MASK MODE subtraction media. ANGIOGRAPHY
technique that is most widely and
11-13: What are the three
easiest to use.
conditions/requirements for
5. This technique in DSA is very useful conventional subtraction technique
in placement of catheters and
• SCOUT FILM
guidewires in complex and small blood
vessel. • ANGIOGRAM FILM-
CONTRAST
ROAD MAP TECHNIQUE
• NO MOTION OF HEAD
6.A technique in peripheral DSA, that
the table and patient moves in three 14. This is a combination of dual energy
stations while the x-ray tube and and temporal subtraction that
detector are remained fix. eliminates

STEPPING TABLE TECHNIQUE HYBRID SUBTRACTION

7. In terms of diagnostic, this is the 15. A method in peripheral DSA that

most acceptable indication why in the tube detector or image intensifier
moves while the table remained fix.
STEPPING GANTRY METHOD 23. DSA is used to diagnose conditions
such as aneurysm, artery stenosis and
16-17:. One important advancement in
vascular malformations
digital fluoroscopy is ROTATIONAL
ANGIOGRAPHY, in which the x-ray TRUE
tube detector rotates 90-180
24. One advantage of dual energy
degrees while acquiring images
subtraction that it require the
18. Another technique in DSA, that the acquisition of images before arrival of
region of interest is exposed to higher contrast material in mask image
kv and lower kv at a short interval time.
FALSE
DUAL ENERGY SUBTRACTION
25. Misregistration doesn’t occur in
19. This technique in DSA is very useful the subtracted images under mask
in cardiac imaging and where mode subtraction, even though there is
consecutive previous frame is movement
subtracted from the current frame.
FALSE
TIME INTERVAL DIFFERENCE
TEST II. EQUIPMENT AND
SUBTRACTION
TECHNIQUES IN
20. Another technique in peripheral INTERVENTIONAL RADIOLOGY
DSA, in which the reference DSA is IDENTIFICATION
overlaid on a teal time fluoroscopic
images. 1-2. What are the two less common
method use for Seldinger Technique?
FLUOROSCOPY FADE TECHNIQUE
TRANSLUMBAR

CUTDOWN
TRUE OR FALSE
3. In basic conversions and
21. DSA provides real-time imaging to measurement, the catheter is
guide surgical and interventional measured in what unit?
radiology procedures for treating
vascular tissues French/Fr

TRUE 4. The abbreviation FNAC needle

stands for?
22. DSA helps in assessing the blood
supply to tumors, aiding in treatment FINE NEEDLE ASPIRATION
planning for oncological interventions CYTOLOGY

TRUE
5. The access needles are used for deployment by smoothly retracting the
entering blood vessels or organs, while outer sheaths back on the inner core.
the biopsy needles are used for what
SELF-EXPANDING BALLOON
purpose?
13. One characteristic of guidewire is
TO GET A SAMPLE CELL/TISSUE
that it is very useful in fluid
6. BONUS environments and when a narrow area
must be transversed and less
7. This is very useful in gripping the
resistance is needed?
wire for torque control particularly
when using hydrophilic wires. HYDROPHILIC

PINVISE 14. What is the contast flow rate for a

5F catheter?
8. This type of catheter allow high flow
of contrast media injection into the 20-25 mls/s
aorta or inferior vena cava.
15. A type of catheter that has a
FLUSH CATHETER pigtail end and very useful for
venography and arteriography.
9. The glide catheter or glidecath is a
hydrophilic type of catheter with many PIGTAIL/OMNIFLUSH
tip type. What is the degree of
16. This is a type of access needle that
angulation for the tip of the glidecath?
are very simple to use but require a
45 DEGREES double wall puncture

10. This are small catheters that are TWO PART NEEDLE
specially designed to fit coaxially
17. A type of biopsy needle that is used
within the lumen of the standard
to get a sample of tissue
angiographic catheter.
CORE NEEDLE
MICROCATHETER
18. This is a commonly used
11. What type of vascular sheaths that
microcatheter in peripheral
is placed on the contralateral side
vasculature used to facilitate
after crossing over the aortic
embolization of bronchial arteries, GI
bifurcation?
bleeds etc.
BALKIN’S CROSSOVER SHEATH
PROGREAT CATHETER
12. This is the most common and
19-20. Microcatheters commonly used
modern stents, usually very simple
for embolization of intracrania
aneurysm.
ECHELON 90

EXELSIOR SL 10

ENUMERATION

21-25. EXAMPLE OF HYDROPHILIC

GUIDEWIRES

• GLIDEWIRE 0.018 INCH

• GLIDEWIRE 0.035 INCH

• V18

• STIFF GLIDE

• ROADRUNNER

26-30. EXAMPLE OF NON-

HYDROPHILIC GUIDEWIRES

• NITREX

• COPE

• BENTSON

• NEW YORKER

• ROSEN

• AMPLATZ

• LUNDERQUIST

• MEIER