The coronary tree tool is used in multiple EncaptureMD applications. Cardiac Cath, Coronary CT and Cardiac MRI all use the tool. This article will review the use of the tool in general. Please refer to the individual app to see how it is used in that context.
Video
Overview
The Coronary Tree tool resides on the Coronary Tree tab in EncaptureMD in all apps.
The screen is divided into 4 parts:
- The header which contains tools for high level adjustments to the tree.
- The menu which allows the user to add coronaries, collaterals, grafts and various pathologies.
- The canvas which is where the coronary tree is built.
- The text output which is the area where the program creates text from information in the drawing.
Header
- The tool allows for two drawings - one pre-op and one post-op. For diagnostic studies only, there is no post-op. When a post-op is needed, do the pre-op and then switch. The details from the pre-op will be present and can then be modified.
- Undo and redo buttons are available
- Check the box to add a Ramus branch at the junction of the LAD and Cx.
- Choose 1,2 or 3 OM's. They'll be drawn along the Cx
- Choose 1,2 or 3 Diagonals. They'll be drawn along the LAD
- Reset back to the starting drawing and wipe out any text
- Use this tool to load a previous coronary diagram to act as a new starting point. If there is one or more than one study, use the combo box to choose. In the example below, this study has no previous so it is new to the system.
- Set the dominance. It defaults to Right Dominant which is 90% of cases.
Menu
Branches
- Drag the coronary to its origin. Then adjust the distal end. The vessel can also be curved by click-dragging in the middle of the vessel.
- The vessel will be automatically named. Moving the vessel to another location or to a different side of the parent vessel will result in a renaming.
- Right click anywhere on the vessel and its caliber, tortuosity and other parameters can be adjusted.
- In the example, tortuosity begins at the (3) right click spot and can be adjusted for degree via a combo box. Vessel caliber can be changed as well.
Collaterals
Collaterals are often used to indicate microvessel flow to a severely or completely blocked vessel from another distribution. Drag the collateral indicator into the canvas and connect the origin and destination vessels as suggested below. If the destination vessel is completely blocked, it will be grayed out, but at the collateral point, it will appear to fill again.
Lesions/abnormalities
- Drag a lesion into a vessel. You can use the arrows to reposition and also set the size of the lesion.
- Right clicking on the lesion will pop up this dialog box.
- Type includes undefined, concentric and eccentric
- Severity can be 0-100%. Once 100% the vessel will be grayed out indicating complete blockage
- Length can be discretely defined, but it is more common to just use the arrow to indicate the approximate length.
- TIMI grade flow can also be indicated and a comment added if required.
Each lesion or abnormality has similar functionality to adjust size and right click to adjust severity, etc. The choices available for the other lesions are consistent with the type of lesion chosen. Calcification, for example, only has qualitative severity.
Grafts
- Right click on Graft icon - Graft type is either artery or vein. Caliber very small to large.
- Choose vein and then drag a SVG from the AO root to the destination vessel, in this case, the first OM.
- Choose artery and then drag from the LIMA branch off the aortic arch to the destination vessel
- You can put lesions inside grafts
- Grafts can also be curved
- Vein grafts can be Y'd
- RARE - Grafts can also originate from the (R) or RIMA or the (G) gastroepiploic vessels seen at the left corners of the canvas.
Stents
Drag and drop a stent into an artery. Set the type, length, width, date, pre-TIMI flow and any comments. If a date is selected, pre and post procedure information will be seen. If not, the assumption is that it is a diagnostic study and the text is included in the diagnostic portion of the report
Canvas
Text output
The text can be edited, but if you change the diagram, any edits will be over-written. Wait until the end of drawing to edit. The report can also be edited in other places.
Note: this area will be blank until the diagram is touched and clicking the Reset button will return this to blank.
