Welcome to the Ultimate Masterclass in Virtual Interventional Radiography:

Mastery from Console to Cath Lab.

As your course host, I designed this curriculum specifically for radiology students,
clinical interns, and fresh graduates who find the fast-paced, high-stakes environment of
Interventional Radiology (IR) intimidating. IR is the absolute pinnacle of advanced
clinical radiography. Here, you are not just capturing static diagnostic images; you are
an active, vital part of a sterile surgical team utilizing real-time digital fluoroscopy,
advanced angiography, and 3D rotational cone-beam CT to guide micro-catheters,
deploy life-saving stents, and embolize hypervascular tumors. It demands an absolute
mastery of vascular anatomy, sophisticated digital post-processing, rapid-pulsed
radiation physics, and meticulous sterile technique.
This paid masterclass is organized into comprehensive, sequential modules. We begin
with foundational angiographic physics, specialized injector systems, and cath lab
safety before embarking on a deep-dive clinical journey covering non-vascular
percutaneous interventions, peripheral arterial disease, emergency
embolizations, and cardiac/neuro-interventions. Every procedure is broken down
into our four core pillars: Dynamic Angiographic/Sectional Anatomy, Pathological
Indicators, Precise Patient Posturing & Tray Setup, and Console Matrix
Operations (DSA/Roadmapping).
Module 1: Foundational IR Physics, Cath Lab
Architecture, & Real-Time Console "Knobology"
Objective: Master the underlying physics of high-output pulsed fluoroscopy, automated
contrast delivery, and active digital subtraction.
Lecture 1.1: The Interventional Angiography Suite & Ceiling-Mounted
Gantries
 Theoretical Core: The physics of high-heat capacity X-ray tubes (liquid metal
bearings, high kilowatt ratings) necessary for prolonged screening and rapid-
sequence acquisitions. Comparing large-format Flat-Panel Detectors (FPDs) to
multi-axis ceiling or floor-mounted C-arm gantries capable of rapid rotational
sweeps.
 🎬 HANDS-ON DEMONSTRATION VIDEO: Inside the Interventional Matrix. A
live camera tour of a state-of-the-art biplane IR suite. Watch the instructor
demonstrate the fluid mechanical movements of the table and gantry, showing
how to safely rotate the C-arms into extreme LAO Cranial or RAO Caudal
angulations without contacting the patient or the sterile field.
Lecture 1.2: Mastering Advanced Console Post-Processing: DSA & Live
Roadmapping
 Theoretical Core: The mathematical physics of Digital Subtraction Angiography
(DSA): capturing a pre-contrast "mask" frame, subtracting bone and soft tissue
densities, and leaving only the contrast-filled vascular lumen visible. Demystifying
live roadmapping, pixel shifting (to correct for patient motion artifacts), and land-
marking techniques.
  🎬 HANDS-ON DEMONSTRATION VIDEO: The Post-Processing Console Lab. A
direct screen capture of the acquisition workstation. Watch the instructor execute
a live pelvic roadmap sequence, apply a manual pixel shift to correct for bowel
gas movement, and use electronic magnification and land-marking parameters to
isolate a narrow arterial target branch.
Lecture 1.3: Automated Power Injectors & Contrast Optimization
 Theoretical Core: Fluid dynamics and mechanics of high-pressure automated
injectors. Configuring injection parameters: total volume ($mL$), flow rate ($mL/\
text{sec}$), pressure limits ($psi$), and linear rise time ($sec$) tailored to
different vascular beds (e.g., Aortogram vs. Selective Renal Angiogram).
 🎬 HANDS-ON DEMONSTRATION VIDEO: Programming the Power Injector. A
step-by-step video guide showing how to safely purge air from a dual-syringe
power injector, load iodinated contrast media and sterile saline, and program a
specific dual-phase delivery profile on the touchscreen interface interface.
Lecture 1.4: High-Stakes Radiation Safety & Scatter Management
 Theoretical Core: Managing high cumulative radiation doses in IR. The
radiobiology of deterministic effects (skin burns, hair loss). Operating pulse rate
reductions (e.g., dropping from $15\text{ pps}$ to $7.5\text{ pps}$), configuring
low-dose fluoroscopy protocols, and maximizing the physical placement of lead
acrylic shields and table drapes.
 🎬 HANDS-ON DEMONSTRATION VIDEO: The Safe Zone Scatter Map. Watch
the instructor use an active real-time dosimeter system during a simulated long-
duration embolization procedure. See how moving the lead shield just inches or
stepping to the detector side instead of the tube side drastically drops the
operator's scatter radiation reading.
Module 2: The Interventional Toolkit — Wires,
Catheters, Sheaths, & Sterile Prep
Objective: Command the physical properties, sizing mechanics, and sterile deployment
of standard IR access devices.
Lecture 2.1: Sizing Metrics & Material Mechanics of the IR Toolkit
 Theoretical Core: Mastering the French sizing system ($1\text{ French} = 0.33\
text{ mm}$) for vascular sheaths and catheters, and the inch system (e.g.,
$0.035"$ or $0.014"$) for guidewires. Understanding material mechanics:
hydrophilic coatings (Glidewires), braided catheter shafts for torque response,
and shape memory configurations (Cobra, Bernstein, Pigtail, Mikaelsson).
 🎬 HANDS-ON DEMONSTRATION VIDEO: The Tactile Toolkit Inspection. A
close-up video showing the instructor handling various wires and catheters. See
how a hydrophilic wire behaves when activated with sterile saline, look at the
difference in catheter tip designs under a high-definition camera, and learn how
to read sizing labels on device packaging to avoid mismatching tools.
Lecture 2.2: Vascular Access Mechanics: The Seldinger & Modified
Seldinger Techniques
 Theoretical Core: The precise physical and geometric steps required to achieve
safe, ultrasound-guided arterial or venous percutaneous access. Managing the
sequence: entry needle, guidewire insertion, needle removal, track dilation, and
vascular sheath placement.
 🎬 HANDS-ON DEMONSTRATION VIDEO: The Seldinger Access Simulation. A
live-action clinical demonstration using a high-fidelity vascular access phantom.
Watch the instructor hold a micro-puncture needle, achieve flashback of pulsatile
blood under ultrasound guidance, smoothly thread a $0.018"$ wire, and
exchange it for a standard $5\text{ French}$ vascular access sheath.
Lecture 2.3: Managing the Sterile Back-Table Matrix
 Theoretical Core: Principles of absolute surgical sterility in the cath lab. Setting
up the main table, handling multi-lumen flushing systems, preparing high-
pressure manifolds with heparinized saline, waste management lines, and
tracking sterile fields during device exchanges.
 🎬 HANDS-ON DEMONSTRATION VIDEO: The Back-Table Setup Masterclass.
Watch the instructor organize an IR sterile back-table from scratch. Learn how to
arrange bowls, set up a 3-way stopcock manifold system, flush catheters
systematically to prevent catastrophic air emboli, and maintain a pristine sterile
field during high-speed exchanges.
Module 3: Non-Vascular Percutaneous Interventions
Objective: Guide needles and place drainage catheters through solid organs and fluid
spaces under real-time fluoroscopic and cone-beam CT monitoring.
Lecture 3.1: Percutaneous Nephrostomy (PCN) & Biliary Drainage (PTBD)
 Theoretical Core: Dynamic cross-sectional and projection landmarks of the
renal collecting system and the intrahepatic biliary tree. Managing acute
obstructions (hydronephrosis, malignant jaundice) via percutaneous access path
tracking.
 🎬 HANDS-ON DEMONSTRATION VIDEO: The PTBD Access Sweep. A live
video recording showing a percutaneous transhepatic biliary drainage procedure.
Watch how the instructor coordinates an initial ultrasound-guided liver puncture,
switches instantly to live fluoroscopy to inject water-soluble contrast to opacify
the dilated ducts, and steps through wire navigation past a stricture into the
duodenum.
Lecture 3.2: Catheter Care, Exchange Mechanics, & Hydrostatic Pressures
 Theoretical Core: The physics of locking pigtail drainage catheters (e.g., Mac-
Loc systems). Managing retention suture strings, tracking gravity-fed external
drainage bags, and performing safe regular catheter patency flushes.
 🎬 HANDS-ON DEMONSTRATION VIDEO: The Pigtail Locking & Exchange
Clinic. Watch a close-up demonstration of a locking drainage catheter
mechanism. See the instructor unlock a clogged drainage catheter over a wire
under fluoroscopic guidance, slide it out safely, and deploy a fresh locking pigtail
catheter into a collection pocket.
Lecture 3.3: Console 3D Cone-Beam CT (CBCT) Configuration
 Theoretical Core: The technology of performing an intraprocedural CT-like scan
using a rotating C-arm gantry (Cone-Beam CT / DynaCT). Reconstructing multi-
planar slices to verify needle or drain tip placement relative to surrounding
anatomy and vascular structures.
 🎬 HANDS-ON DEMONSTRATION VIDEO: Executing a DynaCT Sweep. Live
console capture paired with room cameras. Watch the gantry execute a rapid
$200^\circ$ rotational sweep over the patient couch, and watch the acquisition
workstation instantly process the raw projection data into high-resolution multi-
planar sectional slices confirming perfect catheter positioning inside an abscess
cavity.
Module 4: Peripheral Arterial Interventions & Venous
Insufficiency Management
Objective: Execute lower limb diagnostic angiograms, traverse tight arterial occlusions,
and perform advanced venous reconstructions.
Lecture 4.1: Angiographic Anatomy of the Aorto-Iliac & Femoro-Popliteal
Tracts
 Theoretical Core: Radiographic layouts of the abdominal aorta bifurcation,
common iliac, internal/external iliac, common femoral, superficial femoral (SFA),
popliteal, and anterior/posterior tibial arteries. Tracking collateral pathways in
chronic limb-threatening ischemia (CLTI).
 🎬 HANDS-ON DEMONSTRATION VIDEO: The Lower Limb Bolus Chase
Sweep. A live acquisition sequence demonstrating a digital stepping angiogram.
Watch how the table moves automatically down the patient's legs, tracking a
single bolus injection of contrast from the infrarenal aorta down to the plantar
arches of the feet on a unified subtracted screen.
Lecture 4.2: Percutaneous Transluminal Angioplasty (PTA) & Stenting
Mechanics
 Theoretical Core: The biophysics of vessel remodeling using angioplasty
balloons and stents. Differentiating balloon compliance profiles (high-pressure vs.
cutting balloons), self-expanding nitinol stents (for highly mobile peripheral
joints), and balloon-expandable stents (for high radial strength needs).
 🎬 HANDS-ON DEMONSTRATION VIDEO: The Balloon Inflation Lab. Watch the
instructor treat a severe stenosis of the Superficial Femoral Artery (SFA). See the
wire cross the lesion, watch how an angioplasty balloon is tracked over the wire
into position, and watch the instructor operate an inflation device device
(Indeflator) to monitor pressure ($Atmospheres$) while watching the balloon
waist disappear under live fluoroscopy.
Lecture 4.3: Deep Venous Access & Inferior Vena Cava (IVC) Filter
Operations
 Theoretical Core: Structural landmarks of the IVC relative to the renal veins.
Clinical indications for temporary or permanent mechanical filter deployment to
 prevent fatal pulmonary embolisms, and the micro-hook alignment mechanics
required for filter retrieval.
 🎬 HANDS-ON DEMONSTRATION VIDEO: The IVC Filter Deployment Suite.
Watch an intraoperative sequence where a retrieval-hook filter is deployed via a
jugular approach. See how a preliminary iliocaval DSA map identifies the lowest
renal vein branch, how the filter delivery sheath is aligned, and see the exact
manual unsheathing motion used to lock the filter anchor legs symmetrically
against the vena cava walls.
Module 5: Embolization Therapies, Oncology
Interventions, & Hemorrhage Control
Objective: Administer targeted particulate and liquid embolic agents to occlude
abnormal vascular beds, treat acute hemorrhages, and deliver direct chemo-
therapeutics.
Lecture 5.1: Transarterial Chemoembolization (TACE) & Selective Internal
Radiation Therapy (SIRT)
 Theoretical Core: Hepatic vascular anatomy and the dual blood supply of the
liver (hepatic artery vs. portal vein). The oncology logic of super-selective micro-
catheterization to deliver high-dose chemotherapeutic/radioactive agents directly
to a tumor bed while simultaneously occluding its arterial supply.
 🎬 HANDS-ON DEMONSTRATION VIDEO: The Super-Selective TACE Sweep.
Watch a clinical case targeting a hepatocellular carcinoma (HCC) nodule. See
how the instructor uses a micro-catheter to track deeply past the main hepatic
branches into a segment-4 sub-branch, executing a micro-DSA series to map the
tumor blush before administering a mixture of Lipiodol and chemotherapeutic
agents.
Lecture 5.2: Uterine Artery Embolization (UAE) & Acute Trauma
Hemorrhage Control
 Theoretical Core: Pelvic vascular networks and collateral pathways. Selecting
specific embolic agents: calibrated polyvinyl alcohol (PVA) microspheres for
fibroid infarctions, temporary gelfoam slurries for acute pelvic/splenic trauma
fractures, and permanent metallic coils for visceral aneurysms.
 🎬 HANDS-ON DEMONSTRATION VIDEO: The Trauma Coiling Run. A high-
speed emergency sequence tracking active contrast extravasation (bleeding)
from a ruptured internal iliac branch in a trauma patient. Watch how the instructor
navigates a micro-catheter directly to the site of injury and pushes a series of
micro-coils under live fluoroscopy, achieving complete stagnation of blood flow.
Lecture 5.3: Endovascular Aneurysm Repair (EVAR/TEVAR) Principles
 Theoretical Core: Structural layout of abdominal and thoracic aortic aneurysms
(AAA/TAA). Sizing constraints, landing zone requirements, and endoleak
classifications (Types I-V) during and after stent-graft deployment.
 🎬 HANDS-ON DEMONSTRATION VIDEO: The EVAR Graft Deployment. Watch
a complex endovascular repair of an abdominal aortic aneurysm. See the
introduction of giant delivery sheaths via bilateral femoral access, the precise
 placement of the main bifurcated aortic body graft just below the renal arteries,
and the deployment of the contralateral graft limb under live roadmapped
guidance.
Module 6: Advanced Neuro-Interventions & Stroke
Management
Objective: Navigate tortuous intracranial vessels and operate high-stakes mechanical
thrombectomy and aneurysm coiling systems.
Lecture 6.1: Cerebrovascular Anatomy & Intracranial Navigation
 Theoretical Core: Angiographic layouts of the aortic arch patterns (Type I, II, III),
carotid bifurcations, the Circle of Willis, and anterior vs. posterior cerebral
circulation. Understanding the extreme technical demands of tracking highly
flexible micro-catheters over micro-guidewires ($0.014"$) into delicate
intracranial vessel structures.
 🎬 HANDS-ON DEMONSTRATION VIDEO: Navigating the Arch. Watch the
instructor perform a selective diagnostic carotid angiogram. See the technique for
using a Simmons or Vermulen shape catheter to selectively hook a tortuous left
common carotid origin out of a Type III aortic arch, advancing a long sheath to
establish a stable tower of support.
Lecture 6.2: Acute Ischemic Stroke Interventions — Mechanical
Thrombectomy
 Theoretical Core: Pathophysiology of acute large vessel occlusions (LVO) in the
brain. Understanding the mechanisms of stent-retriever systems (Solitaire,
Trevo) and direct large-bore aspiration catheters (ADAPT technique) to restore
cerebral perfusion within critical stroke time windows.
 🎬 HANDS-ON DEMONSTRATION VIDEO: The Emergency Mechanical Clot
Retrieval. An emergency thrombectomy run targeting an M1 segment occlusion
of the middle cerebral artery. Watch a split-screen layout: the live biplane
fluoroscopy displays the aspiration catheter tracking to the face of the clot, the
deployment of a stent retriever, a timed pause for clot integration, and the
manual extraction sequence showing immediately restored flow down the
cerebral branches.
Lecture 6.3: Intracranial Aneurysm Coiling & Flow Diverter Stents
 Theoretical Core: Hemodynamics of intracranial aneurysms. The physics of
regular detachable coils (using mechanical or thermal detachment console
systems) and the mechanical physics of flow-diverting stents that bridge an
aneurysm neck to bypass internal blood flow.
 🎬 HANDS-ON DEMONSTRATION VIDEO: The Intracranial Detachable Coiling
Matrix. Watch the instructor treat a wide-necked posterior communicating artery
aneurysm. See how a micro-catheter is carefully positioned inside the aneurysm
sac under high-magnification biplane roadmapping, how the first framing coil is
deployed, and watch the physical activation of the detachment hand-switch on
the console to release the coil safely.
Module 7: Masterclass Wrap-Up, Complication
Management, & Interactive Grand Rounds
Objective: Troubleshoot advanced vascular artifacts, navigate catastrophic
complications, and award certificates.
Session 7.1: Troubleshooting Vascular & Angiographic Artifacts
 Theoretical Core: Correcting misregistration artifacts caused by patient
breathing, swallowing, or cardiac motion. Managing grid-cutoff anomalies in high-
angulation obliques, and optimizing contrast transitions across dense bone
backgrounds.
 🎬 HANDS-ON DEMONSTRATION VIDEO: The Matrix Misregistration Rescue.
Live workspace session where the instructor reviews a highly distorted carotid
angiogram ruined by a patient swallowing. See how to open the console analytics
menu, perform manual frame-by-frame pixel shifting, and execute a new mask
subtraction to extract a perfectly clear, diagnostic arterial image.
Session 7.2: Critical Complication Management Protocols
 Theoretical Core: Rapid recognition and endovascular management of
catastrophic intraprocedural emergencies: acute arterial dissections, vessel
ruptures, vasospasms, and retroperitoneal hematomas.
 🎬 HANDS-ON DEMONSTRATION VIDEO: The Vessel Rupture Drill. A high-
stress simulation inside the cath lab. Watch how the team responds to an
immediate vessel rupture during a peripheral intervention: the instructor instantly
drops the console to low-dose continuous screening, inflates an angioplasty
balloon proximal to the perforation site to control bleeding, and preps a covered
stent graft for deployment.
Session 7.3: Certification Ceremony & Neuro/Vascular Grand Rounds
 Theoretical Core: A comprehensive, interactive review of ten challenging real-
world interventional cases—spanning from an emergency pelvic trauma
embolization to a life-saving acute ischemic stroke mechanical thrombectomy.
 🎬 HANDS-ON DEMONSTRATION VIDEO: The Combined IR Case Review
Showcase. A final workstation layout demonstration showing how to stitch multi-
segment peripheral angiograms, analyze pre-and-post 3D perfusion maps, and
export final subtracted datasets to the clinical archive, followed by the
presentation of masterclass completion certificates.
Your Next Step
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