Fundamentals of Fluorescein Angiography
Quality Issues

Timothy J. Bennett, CRA FOPS
Department of Ophthalmology
Penn State University
Hershey, Pennsylvania

When conditions are favorable, angiographic images can be quite dramatic and worthy of display or publication. Unfortunately not all angiograms will be this high in quality. It is important however, for each angiogram to be of adequate and consistent diagnostic quality. Quality results are dependent on a number of factors. The skill of the angiographer and the optical and mechanical quality of the instrumentation can have a direct effect on quality. There are a number of common factors that can adversely affect angiographic quality. They include: the presence of media opacities, inadequate pupillary dilation, poor fixation, inadequate patient cooperation and extravasation of the dye. Some of these factors are beyond the direct control of the angiographer, but every attempt should be made to minimize their detrimental effects.

Since fluorescein angiography is a dynamic process, successful results depend on complete preparation before the dye is injected. Many angiographers follow a specific protocol or checklist to ensure that everything is ready. Good communication between the ophthalmologist and angiographer is essential to ensure that maximum diagnostic information is obtained. The photographic timing sequence and the angiographer's ability to adapt to changing conditions are also important elements in producing quality angiographic results. Experience is invaluable, especially in managing the patient if complications occur during the critical early phase of the study.