Procedures

Perivision Step by Step Process

Tips for pre-setup of Perivision:

• Before the patient is in the room it is advantageous to check the table movement.  Do this by panning the table all the way in all directions to insure that it is free of any obstructions (i.e. monitor cables)

• Patient in the supine position with the feet / knees as close together as possible in the true anatomical AP position.  The patient should be centered.

• Tape the Foley catheter directly in the center between the legs with the distal aspect being taped around the left foot and off the side of the table.

• When possible tape the feet together to prevent patient motion. (Tape will need to come off following runoff)

• The left arm should be secured properly tight against their person to prevent collision with the C-Arm and potential injury.

• The power injector should be placed on the left side of the patient and filled with 100ml visipaque.  The cable should be passed under the table and plugged into the table unit.  (If the cable isn’t pushed far against the table base you may have a collision with the lower aspect of the C-Arm.   If the C-Arm is rotated in LAO and stops abruptly suggest moving the cable!)

• The patient should be on the table with their head all the way to the top of the table.  This will allow you to capture the entire length of the lower extremities on taller patients.

• The Omni Flush catheter should be placed in the lower abdominal aorta at the level of the iliac bifurcation.  The injector tubing should be connected to the catheter and injector syringe and placed down.  Secure the catheter and tubing using the blue clips to the drape.

PERIVSION STEPS:

1. Center the patient with the FOV (field of view) centered over the pelvis insuring that the tip of the catheter is within the top FOV.  The table should be elevated to the highest position followed by the image detector down to the patient.  (“TABLE UP, TUBE DOWN”) To decrease the magnification to (“48cm”)
2. On the control panel select under the Acquisition Module: “PERIVISION” P332211.(THIRD PAGE FROM THE TOP)
3. Once selected fluoro the image to confirm the “start” position.
4. To advance to the next position you must push down on the gantry control button and deflect the joystick toward the patient head until the next position is reached.
5. Following the table movement fluoro and confirm patient position.  Use the soft collimators to avoid having image “burn-out.”  Press the soft collimator button to toggle between center and side collimators.
6. The steps from 4 & 5 should be repeated until you have reached the feet or in the case of taller patients your final position in the bolus chase is reached. (i.e.“6 of 6”)
7. At this point you are prepared for the mask & acquisition phase of the runoff.
• Clear staff and physicians away from the table
• Arm the injector (77ml Volume @ 7ml/s Rate ; 850 psi ; 0.3 rate of rise)
• Bring the injector control switch to the foot of the table and hold the acquisition controller in the opposite hand (located under the foot of the table)
• Press and HOLD the acquisition button.  The mask phase will start by taking individual snap shots of each position.  The table will be moving as it does this to the start position.  The MD is typically giving breathing instructions at this point and the patient should be holding their breath as the table reaches the start position.
• The acquisition button should still be depressed at this point.  As the table reaches the start position the final mask will be obtained and the screen should go “grey” signifying the DSA mode has commenced.   This is when the injector control switch should be activated.  Contrast will begin to fill the lower aorta and iliacs.
• At peak opacification depress the BLUE table control button located on the acquisition switch to advance the table to the next acquisition position.
• As the table moves and the acquisition reappears you will see contrast most likely entirely filled in the next phase of blood vessels.  Allow 2-3 frames (1sec) to be taken and repeat the steps until the end of the acquisition.

The runoff should be complete. 

A few pointers:

• With the presence of PAD the runoff may not be uniform bilaterally.  In this case it is preferred to communicate quickly to ask which vessel to follow.  Healthy or Diseased?  Most often the healthy vessel is followed as the diseased vessel requires additional angiograms.

• If during the test phases the patient legs appear to be off remembering you cannot pan the table, you must move the legs or ankles within the FOV.  The pelvis should already be centered.

• Each position is overlapped by 1/3 of the next position.  If you press the table movement button too early in this case you will still be covered on the next position.

REMEMBER TO ALWAYS HOLD THE X-RAY ACQUISITION BUTTON UNTIL THE END OF THE STUDY.