X-Ray

Question 1

Which view (LOA or RAO) shows the CS take off angles and bifurcations?

Answer 1

RAO

Question 2

Which view (LOA or RAO) shows RV lead apex to basal separation?

Answer 2

RAO

Question 3

Which view (LOA or RAO) is the best to show RV and LV lead slack?

Answer 3

LAO

Question 4

Which view (LOA or RAO) is the best lead to see the distance between the RV and LV leads?

Answer 4

LAO

Question 5

What does RAO and LAO stand for?

Answer 5

• RAO = Right Anterior Oblique

- LAO = Left Anterior Oblique

Question 6

What x-ray view are you looking at If a “Frog Face” is seen on the image?

Answer 6

AP or antero-posterior view

Question 7

What are clues that an AP x-ray was taken?

Answer 7

• “frog face” seen or the fascicles (eyes) and vertebral body
• sternum or sternal sutures are directly over the spine
• equal right and left rib length

Question 8

What are clues that an RAO x-ray was taken?

Answer 8

• RV lead elongation will be seen
• spine or spinal processes on the left side of the image
• sternal wires on the right side of the image
• tarantula sign (sternum with ribs coming off)

Question 9

In what x-ray view will the spine or spinal processes be on the left side of the image?

Answer 9

RAO

Question 10

In what x-ray view will the sternal wires be on the right side of the image?

Answer 10

RAO

Question 11

In what x-ray view will RV lead elongation be seen?

Answer 11

RAO

Question 12

What is the best x-ray view to verify apical RV lead placement?

Answer 12

RAO

Question 13

What are clues that an LAO x-ray was taken?

Answer 13

• spine/spinal processes on the right side of the image
• spine runs down the middle of the heart
• sternal wires on the left side of the image
• rounded left cardiac silhouette border

Question 14

In what x-ray view will RV lead foreshortening be seen?

Answer 14

LAO

Question 15

What is the position of the LV if it is pointing towards the patients left in an LAO image?

Answer 15

lead is anterior and needs to be move

Question 16

What is the ideal placement of the LV lead viewing an LAO image?

Answer 16

lead is pointing towards the patients right and is in between the 2 and 5 o’clock position

Question 17

Which view is used to see if the RV lead is in apically placed?

Answer 17

RAO

Question 18

Which lead is best to see if the RV lead is septal in placement?

Answer 18

LAO

Question 19

Where is the RV lead placed if it pointing up and away from the spine in an LAO image?

Answer 19

lead is in the RV free wall and needs to be repositioned

Question 20

How can you tell if the RA is in the RAA while viewing an LAO image?

Answer 20

• the tip of the lead will be parallel to the rest of the lead
• pointed up and will see “windshield wiper” motion under live fluoroscopy

Question 21

Where is the RA lead positioned if the tip of the lead is pointing medially or towards the spine in LAO view?

Answer 21

• lead is in the atrial septum

- lead appears to have a more “J” curved shape

Question 22

Where is the RA lead positioned if the tip of the lead points superiorly or appears parallel to the body of the lead when viewing in the LAO view?

Answer 22

• lead is in the Right Atrial Appendage (RAA)

- lead appears to have tight “J” shaped curve

Question 23

Where is the RA lead positioned if the tip is pointed away from the spine while viewing in the AP view?

Answer 23

lead is on the lateral wall

Question 24

Why is the lateral wall a bad position for atrial lead placment?

Answer 24

• wall is thin and phrenic nerve runs along the right and left lateral walls of the heart