Вау, отдельный форум сделали! Супер!
Насчет интракраниальных отделов неплохо написано у Масарика в книге "Endovascular Techniques in the Management of Cerebrovascular Disease" (2008), могу кусочек процитировать:
Standard angiographic projections and acquisition parameters
Clearly, the limitations lie with either inexperienced or indifferent operators and technologists; however as the ‘captain of the ship’, the operator carries ultimate responsibility for optimal images. By convention, radiographic projections are named according to the direction of the X-ray beam from source to target. Standard PA and lateral digital subtraction runs are performed at 2 frames per second for most disorders. For high-flow lesions (e.g. direct arterial–venous fistulae) the rate may be increased to 6 frames per second; above this level there are often trade-offs in image quality (signal-to-noise, spatial resolution). Injections of contrast 6–8 ml in the carotid artery 3–5 ml in the vertebral artery with 240–300 mg/ml of iodine solution typically produces excellent opacification of the intracranial vessels. Arterial–venous circulation is usually 4.5–6.0 seconds, necessitating exposures lasting approximately 7–10 seconds or between 14 and 20 images. PA and lateral views are standard for most ischemic stroke studies, which should include the opacified vascular territories centered in the image but magnified just enough to include the draining dural sinuses ( Figures 2.6, 2.7). The PA image should be positioned such that the superior orbital rim overlies the petrous ridge (see Figure 2.7). In the lateral projection, the orbital roofs will not overlap (the bony orbit distant to the detector will appear magnified) but should be parallel (see Figure 2.6 ). Once the screening dynamic study is claimed, high magnification and angulated views may be obtained to demonstrate the pathology to greatest advantage. For some lesions, such as aneurysms, these runs may be limited to the arterial phase only in order to reduce radiation exposure. Additional views include transorbital obliques (the Reese view) to display anterior circulation aneurysms at the circle of Willis ( Figure 2.8 ). The degree of right–left obliquity (yaw of the C-arm) is defined from midline sagittal. For projections using cranial–caudal angulation, the degree of pitch is defined according to the zero line drawn from the canthus of the eye to the external auditory meatus (the canthomeatal line). Caldwell or Waters views can provide cranial–caudal angulation of lesions at the M1 segments of the middle cerebral arteries or those along the basilar trunk (Figures 2.9, 2.10 ). The Townes view is the optimal means to visualize the distal (P2, P3) posterior cerebral pial vessels (Figure 2.11). Alternatively submental vertex positioning is often an excellent means to visualize complex anatomy at the anterior communicating artery or the M1–M2 junction (Figure 2.12). Often, faithful reproduction and maximum benefit of the submental vertex view will require more than simple gantry angulation: building up of the shoulders and head extension is frequently necessary.
Там еще есть красивые картинки, и без них начинающему будет достаточно трудно представить, как правильно вывести проекцию...например, как завалить трубку краниально от АР, чтобы "superior orbital rim" перекрывала "petrous ridge"
Если очень нужно, могу как-нибудь попозже выложить эту книжку.
Я видел, как работают нейроинтервенторы в НИИ Поленова: если больной первичный, то снимают все интракраниальные брахиоцефалы одновременно в 2-х проекциях (сбоку и в АР с небольшим краниальным смещением), в случае аневризмы делают еще ротационную ангиографию (они ее называют "пропеллер")
, и затем просматривают ее по кадрам, выбирая оптимальную проекцию для операции (как уже писал Сергей Александрович)...при этом ругаяcь, что у них украли 3D при монтировании установки