Introduction to FFRangio

Using FFRangio in the cardiac cath lab 

Coronary angiography for FFRangio

The first step to utilizing FFRangio is to take at least 3 angiograms of the target vessel.

Guidelines for image acquisition

1) Optimal visibility and presentation of the lesion

2) At least 30 degrees between views

3) Full opacification of whole vessel

4) Complete vessel of interest within the frame without panning

5) Avoid foreshortening & vessel overlap 

6) Minimum 20 frames/sec

7) Minimum 750 x 750 resolution

It is important to take angiograms at optimal projections for FFrangio

Left Anterior Descending Coronary Artery

Minimum of three views that capture the lesion and full LAD with minimal overlap or foreshortening. 

Frame includes complete coronary tree for accurate 3D reconstruction.

Left Circumflex Coronary Artery

Minimum of three views that capture the lesion and full LCX with minimal overlap or foreshortening. 

Frame includes complete coronary tree for accurate 3D reconstruction.

Right Coronary Artery

Minimum of three views that capture the lesion and full RCA with minimal overlap or foreshortening. 

Frame includes complete coronary tree for accurate 3D reconstruction.

Transfer DICOMS to FFRangio

If the transfer of the DICOMS is not automatic, manually transfer cine films to FFRangio. Ensure that a minimum of three of the most appropriate angiograms are transferred for each vessel of interest. 


Which vessel is well displayed?

  • Left anterior descending (LAD)
  • Left circumflex (LCX)
  • Right coronary artery (RCA)

Choose the answer that is NOT appropriate for FFRangio

  • Ensure optimal visibility of the lesion
  • Vessels are well opacified and full vessel of interest within the frame
  • Avoid foreshortening
  • Avoid overlap
  • Frame rate of at least 10/sec
  • Resolution of greater than 700 x 700
  • Panning is important to capture the full vessel

Getting Started with an FFRangio analysis

Open a New Case

Choose Patient and Start New Analysis

Choose a patient by clicking on the line with the patient name and then click on new analysis. Alternatively, double click on the line with the patient name and the new analysis will begin.

Four Stages of FFRangio

There Are Four Stages to Complete an FFRangio Analysis

The stage which is highlighted indicates where you are in the FFRangio analysis workflow. Once each stage is complete, it is possible to continue to the next.

Select Stage

Play each angiogram to find the most appropriate films, and select 3 by clicking the check box in the upper left corner or double clicking the image. The selected angiograms will be highlight with a green border. Click to choose the target vessel and input the mean arterial pressure (MAP).  Once completed, click proceed, or "Lesion" on the tool bar.

Lesion Stage

The lesion stage is the foundation for the FFRangio analysis. The end diastolic frame, vessel ostium and lesion location are all determined in this stage. 

1) Play the angiogram to verify or reset the end diastolic frame.

2) Place the green ostium marker on the ostium of the vessel. Use "zoom in", play, forward and back buttons to determine the location of the ostium.

3) Place the red lesion marker on the narrowest point of the coronary stenosis. Use landmarks such as side branches to ensure that the stenosis is on the same point of the vessel in all views. "Zooming in" as well as playing the film is useful for accurate placement.