Fluoroscopy

Real-time imaging
• Most general-purpose fluoroscopy systems use TV
technology, operating at 30 frames/sec
• May be recorded (barium swallow examinations)
or unrecorded (catheter positioning)
• Cinecardiography may operate at 120 fps using
35mm film
• Higher sensitivity than screen-film systems
– 1 to 5 R per frame versus 600 R for a 400-speed
screen-film system to give OD = 1.0
 Image intensifier
• Four principal components:
– A vacuum bottle to keep air out
– An input layer to convert the x-ray signal to
electrons
– Electronic lenses that focus the electrons
– An output phosphor that converts the
accelerated electrons to visible light
 Input screen
• Input screen consists of four layers:
– The vacuum window (thin Al window that is part of the
vacuum bottle)
– A support layer (also thin Al), curved for accurate
electron focusing
– The input phosphor (CsI in thin, needle-like crystals)
– The photocathode (a thin layer of antimony and alkali
metals, such as Sb2S3) that emits electrons when struck
by visible light
 Output phosphor
• Made from zinc cadmium sulfide doped with
silver (ZnCdS:Ag), which emits green light
• Small phosphor particles (1 to 2 m) in a thin
coating (4 to 8 m) to preserve high spatial
resolution
• Anode is a very thin (~ 0.2 m) coating of
aluminum on the vacuum side of the phosphor
 Output phosphor (cont.)
• Much smaller image at the output phosphor
than at the input phosphor (23- to 35-cm
diameter input imaged focused onto a 2.5-
cm diameter circle)
• Must deliver resolution >70 line pairs/mm
to preserve a resolution of 5 line pairs/mm
at the input plane
 Quantum detection efficiency
• X-rays must pass through the vacuum window and
the input screen substrate before reaching the
phosphor
• This reduces the QDE of an image intensifier
• Maximal around 60 kVp
– Dose to patient decreases at higher kVps, so optimal
kVp for a given examination will generally be higher
than 60 kVp
 Modes of operation
• Continuous fluoroscopy
– Basic form of fluoroscopy; continuously on x-ray beam
• High dose rate fluoroscopy
– Specially activated mode allowing exposure rates of up
to 20 R/min to the patient in the US
• Variable frame rate pulsed fluoroscopy
– 30, 15, and 7.5 frames/sec operation allows lower
temporal resolution for parts of procedure
• Frame averaging
 Frame averaging
• Fluoroscopy images generally noisy
• Sometimes beneficial to compromise
temporal resolution for lower noise images
• Digitize fluoroscopic images and perform
real-time averaging in computer memory
for display
I displayed  I n  1    I n 1
 Automatic brightness control
• Purpose of ABC is to keep brightness of the image
constant at the monitor
• Accomplished by regulating the x-ray exposure
rate incident on the input phosphor of the II
– As II pans from a thin to a thick region of the patient,
thicker region attenuates more of the x-rays
• Video signal itself can be used to sense light
output
• ABC can adjust both tube current and generator
voltage
 Image quality
• Spatial resolution of the II best described by
modulation transfer function (MTF)
• The limiting resolution of an imaging
system is where the MTF approaches zero
• Higher magnification modes (smaller fields
of view) are capable of better resolution
• Video imaging system degrades the MTF
substantially
 Image quality (cont.)
• Contrast resolution of fluoroscopy is low
compared with radiography because low
exposure levels produce images with
relatively low signal-to-noise ratio (SNR)
• Excellent temporal resolution of
fluoroscopy is its strength and its reason for
existence
 Fluoroscopy suites
• Smaller facilities may use one fluoroscopic system
for a wide variety of procedures
• Larger facilities have several suites dedicated to
specific applications, such as:
– Gastrointestinal suites
– Remote fluoroscopy rooms
– Peripheral angiography suites
– Cardiology catheterization suites
– Biplane angiography systems
– Mobile fluoroscopy – C arms
 Radiation dose
• Maximum entrance exposure rate for fluoroscopy to the
patient is 10 R/min (see
http://www.hc-sc.gc.ca/hecs-sesc/ccrpb/publication/safety_code20a/toc.htm )
• Low-dose techniques include heavy x-ray beam
filtration, use of low frame rate pulsed fluoroscopy, and
use of lower-dose ABC options
• Last-frame-hold features often reduce fluoroscopy time
• Using the largest field of view suitable to a given
clinical study also helps reduce radiation dose to the
patient
 Dose to personnel
• Occupational exposure of physicians, nurses,
technologists, and other personnel who routinely
work in fluoroscopic suites can be high
• Lead aprons should be worn when the x-ray beam
is on
• Portable lead glass shields should be available for
additional protection to staff members observing or
otherwise participating in the procedure
• Reducing total fluoroscopy time is beneficial to
everyone