International Atomic Energy Agency

X-Ray Production-
RADIOGRAPHY

Module VIII.3 - Part 1: Design

considerations for the equipment
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 Introduction

• X Rays are used for imaging by different

procedures
• The design of the equipment will have
influence on radiation protection of styaff
and patient
• We wil discuss in this lecture the
equipment and acessories used in these
different modalities

Module VIII.3-Part 1. Design considerations equipment International Atomic Energy Agency

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 Topics

1. General considerations on X-ray

production
2. Projection radiography
3. Fluoroscopy equipment
4. Computed Tomography
5. X Ray beam characteristics
6. Special applications: dental, pediatric

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 Overview

• In this comprehensive lecture on

radiological equipment we will start from
the basic principles of X-ray production
and end with a description of the different
dedicated equipments such as
radiography, fluoroscopy, DSA, CT,…

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 International Atomic Energy Agency

Topic 1: General
considerations on X-ray
production

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 Content of this topic 1 X Ray production

• The physics of X-ray production

• X-ray tube
• Stationary anode
• Rotating anode
• Tube housing
• Diaphragm and filter system
• High voltage generators
• Single phase, 6 & 12-pulse
• Constant potential
• High frequency
Module VIII.3-Part 1. Design considerations equipment International Atomic Energy Agency
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 Physics of X Ray production

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 The physics of X-ray production

• Electrons emitted by cathode

• Accelerated in E-field
• Interaction in target
• Brehmsstrahlung (braking radiation)
• Characteristic lines (line spectrum)
• Efficiency ~1%, 99% heat --> technological problem

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 Brief interaction description

- Slowing down e-
- Along path
stepwise loss Ekin
- Two processes
interactions e- of atom shell
slowing down in nucl field
- Several layers of atoms involved

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 Continuous spectrum (simplified)

a) Thin layer anode: b) Superposition of thin layers:

can be proven that gradually e- beam loses energy,
intensity produced so maximum energy deeper thin
constant all energies layers decreases

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 Spectrum of pure “Brehmsstrahlung”

Dashed line:
X-ray IN tube

Full line:
X-ray outside tube,
low energy filtered

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 Characteristic radiation

Simplified energy Energy level

level diagram diagram for
tungsten (W)

Characteristic radiation: target element specific !

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 Full spectrum: tungsten anode

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X-ray Spectra

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X-ray spectra are composed of:

1. Continuous bremsstrahlung spectra

keV
2. In most cases, discrete spectra peaks known
as characteristic x-rays.

Bremsstrahlung radiation makes up approximately 80% of the x-ray

beam International Atomic Energy Agency
Bremsstrahlung Radiation

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 Bremsstrahlung radiation

X-ray

Projectile electrons originating from the cathode filament impinge on

atoms in the anode and will often pass close by the nucleus of these
atoms.

As the electrons pass through the target atom they slow down,
with a loss in kinetic energy. This energy is emitted as x-rays.
The process is known as bremsstrahlung or International
“braking energy”.
Atomic Energy Agency
 Bremsstrahlung xrays form a continuous energy
spectra. The frequency distribution is continuous and
shows that the Bremsstrahlung process produces more
low energy that higher energy x-rays. The average
energy is approximately 1/3 of the Emax.

E max

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 23keV

70KeV

E max

The Emax or the maximum energy of the x-rays measured as (keV) is

equal to voltage applied to the Xray tube (kilovolt peak or kVp).

For example:
An applied voltage of 70 kVp produces an x-ray spectra with Emax of
70 KeV and average energy of about 23 keV.

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Characteristic X-ray Radiation

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Characteristic X rays

E max

To produce characteristic x-rays the projectile electrons must

have sufficient energy to displace orbital electrons

• If the projectile electron has sufficient energy, it

may cause the ejection of an orbital electron (usually
in the K shell) from an atom in the anode.

• An outer shell electron (usually from the L or M shells) fills the

vacancy in the inner orbital and sheds energy as an x-ray of
characteristic energy.
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Production of Characteristic X-rays

X-ray
K Shell
L shell

M shell
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Note that the impinging electron from the cathode must have
sufficient energy to displace the K shell electron of the anode.

This energy is the excitation energy of the electron shells

and the energy is characteristic for each and each element

For a tungsten anode the electrons from the cathode must have at least
69.5 keV to dislodge a K shell electron.
Consequently no lines will appear if the x-ray tube with a
tungsten anode is operated at 20 kVp or 40 kVp

75keV 40keV
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 Note that characteristic X ray spectra are
independent of voltage once the threshold
values have been reached

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A Schematic X ray Tube

Glass envelope

cathode
anode electron beam
filament

rotor focal spot

Focusing cup

X-ray beam
Window

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 Glass envelope

cathode
anode electron beam

filament

rotor focal spot

Focusing cup

X-ray beam
Window

•The filament is heated to boil off electrons which are

then accelerated to the anode
•The filament is contained within the cathode which is cup shaped to
focus the electrons onto the focus spot on the anode
•Tube currents of 50-800 milliamperes are used whereas filament currents
are in the range of 2-5 amperes
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 •The anode is bevelled at an angle of 12 to 17 degrees in order to
maximise the contact area while focussing the resultant beam

Glass envelope

cathode
anode electron beam
filament

rotor
Focusing cup

•The anode is usually composed of tungsten or molybdenum as it

must withstand very high temperatures (>3000 degrees C)

•Correct warm up and stand by procedures are International

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to maximise tube and filament life
 X-ray tubes

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 Basic components

• Cathode : heated filament which is the source

of the electron beam directed towards the
anode
• Anode (stationary or rotating): impacted by
electrons, emits X-rays
• In vacuum within glass (or metal) envelope
• Metal tube housing surrounding glass X-ray
tube: mechanical and radiation protection
• Shielding material (protection against scattered
radiation)
• Heat (99%!) removal mechanism: air or oil
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 Basic components illustrations
Tube housing Cathode structure

1: long tungsten filament

1: mark of focal spot 2 : short tungsten filament
3 : cathode in tube
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 Cathode
• Cathode includes filament(s) and
associated circuitry
• tungsten material : preferred because
of its high melting point (3370°C)
• slow filament evaporation
• no arcing
• minimum deposit of W on glass envelope
• To reduce evaporation the emission
temperature of the cathode is reached just
before the exposure
• in stand-by, temperature is kept at ±
1500°C so that 2700°C emission
temperature can be reached within a
second
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 Cathode

• Modern tubes have two filaments

• a long one : higher current/lower resolution
• a short one : lower current/higher resolution
• Coulomb interaction makes the electron beam
divergent on the travel to the anode
• lack of electrons producing X-rays
• larger area of target used
• focal spot increased  lower image resolution
• Focalization of electrons is crucial
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 Anode
Rotating anode

Static copper anode stem

with radiator

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 Anode characteristics
• Mechanical constraints (heat!)
• High Z, high melting point, heat reservoir
• Stationary:
• W target on conducting reservoir Cu stem
• Rotating:
• W/Rh target on Mo base (blocks heat to bearings,low moment
of inertia)
• Disk and annular track diameter 5-12 or more cm
(3,000 to 10,000 revolutions/minute)
• Higher dissipation: x 2pr
• Anode angle to reduce focal spot
• Typical between 7 and 20°
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 Heat Removal

• Stationary anode
• By conduction
• From anode via stem to radiator
• Air or oil cooled
• Rotating anode
• By heat radiation
• Anode thermally “isolated” from rotor bearings
• Oil cooled: forced convection

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 Overview drawing of tube in housing

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 The Line-Focus principle

• Anode target plate has a shape that is more

rectangular or ellipsoidal than circular
• the shape depends on : Bi-angular anode
• filament size and shape
• focusing cup’s and potential
• distance between cathode and anode
• Image resolution requires a small focal spot
• Heat dissipation requires a large spot
• This conflict is solved by slanting the target
face
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 Line-focus: apparent focal spot

 Angle „ Angle

Actual focal Actual focal

Incident electron spot size Incident electron spot size
beam width beam width
Increased
apparent
Apparent focal spot size focal spot size

Film Film

Apparent focal spot smaller for smaller angles:

Better spatial resolution
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 Anode heel effect (1)
• Anode angle induces a variation of the X-
ray output in the plane comprising the
anode-cathode axis
• Lower intensity on anode side
• Absorption by anode of X photons with
low emission angle
• The magnitude of influence of the heel
effect on the image depends on factors
such as :
• anode angle
• size of film
• focus to film distance
• Anode aging increases heel effect
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 Anode heel effect (2)

Plot of intensity
shows variation
along anode to
cathode axis

The shorter SID,

the higher heel-
effect

In mammo:
cathode towards
patient (breast)

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 Anode heel effect (3)

• The heel effect is not always a

negative factor
• It can be used to compensate for
different attenuation through parts of
the body
• For example:
• thoracic spine (thicker part of the
patient towards the cathode side of the
tube)
• mammography
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 Focal spot size and imaging geometry

• Focal spot finite size  image unsharpened

• Improving sharpness  small focal spot size
• For mammography focal spot size  0.4 mm
• Small focal spot size  reduced tube output (longer
exposure time)
• Large focal spot allows high output (shorter exposure time)
• Balance depends on organ movement (fast moving organs
giving rise to motion blurring may require larger focus)
• Focus shape&size varies within image plane

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 The high voltage generator

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 X-ray generator (1)

It supplies the X-ray tube with :

• Current to heat the cathode filament
• Potential to accelerate electrons
• Automatic control of exposure (power
application time)
• Electrical energy supplied  1000  X-ray
beam energy ( 99.9% is dissipated as
thermal energy in anode)

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 Tube potential waveform

kV ripple (%) Single phase single pulse

100%
Single phase 2-pulse
13%
Three phase 6-pulse
4%
Three phase 12-pulse
Question: how
do you get 12
pulses???
Line voltage 0.01 s
0.02 s

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 The choice of the number of pulses

• Single pulse : low power (<2 kW)

• 2-pulse : low and medium power
• 6-pulse : uses 3-phase mains, medium
and high power (manual or automatic
compensation for voltage drop)
• 12-pulse : uses two shifted 3-phase
system, high power up to 150 kW
• HF systems:

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 High frequency generator
HF = High frequency
Low ripple
Small volume (U = dF/dt)
Volume savings of 80%, weight savings of 75%.
Excellent mobile units (cable capacity low)
Frequency between 5 and 25kHz for general purpose
Up to 100kHz mobile and mammography

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 What relation to imaging?
Ripple increases image noise

The left image is made with an old (high ripple) generator.

Increased noise led to loss of detail compared to modern equipment

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 Examples of operational and
equipment data

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 X-ray equipment operation mode and
application (1)

Mobile Radiography
Single phase generator or High frequency
output : up to 2 kW @ 1.4 focus size with stationary anode
output : up to 30 kW @ 0.7 focus size with rotating anode

Mammography
Single phase generator or High frequency
output : Mo anode 5 kW @ 0.3 focus size
output : 0.9 kW @ 0.15 focus size (magnification)
AEC with transparency compensation

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 X-ray equipment operation mode and
application (3)
• Radiography and Fluoroscopy
• Over couch equipment, three phase generator
• Continuous output of at least 500 W
•output : 40 kW @ 0.6 focus size for spot film
•output : 70 kW @ 1.0 for fluoroscopy (high resolution)
•priority given to contrast
•automatic settings of kV
• Cardiac angiography
•Three phase generator - continuous output  1kW
•output : 30 kW @ 0.4 focus size
•output : 80 kW @ 0.8 focus size
•frame rate : up to 120 frames/s
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 What we learned on X Ray production

• The spectra produced by accelerated e-

on target
• The X-ray tube: Cathode, Anode, Housing
• The line focus principle and Heel effect
• The high voltage generator
• Some examples of equipment and their
applications

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 International Atomic Energy Agency

Topic 2: Projection radiography

Basic interactions, attenuation, principles of

image formation, the radiography system
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 Basic interactions of X Rays in relation to
imaging

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 X Ray interactions

• Photons and matter

• Absorbed: energy to patient, dose
• Scatter: pass, can loose energy, change direction
• Pass through, unaffected: contribute to image
• Factors affection processes
• Photon energy (radiology: kV, spectrum)
• Medium:
• Density
• Thickness
• Atomic number Z
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 Interactions of minor importance in
radiology
• Not important:
• Photodisintegration: threshold ± 15 MeV !
• Pair production: threshold 1.022 MeV
• Coherent scatter:
• No energy deposition, no ionization, no dose
• But contributes to undesirable scatter
• At diagnostic energies: contribution less than
10% of all interactions

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 Important interactions in radiology

• Photoelectric effect • Compton scattering

Ex: Oxygen
Ex: Ca

Incident g (1) totally absorbed by inner e-

Incoming g (1) interacts with outer e-
ejected as photo e-. Vacancy (3) filled by
(2); the g changes direction (3) and
outer e-; difference emitted characteristic
Compton e- carries away energy (4)
radiation (4) or as Auger e- (5)

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 Factors influencing PE Effect
• Photon energy (h) > electron binding energy
EB
• The probability of interaction decreases as h
increases
• It is the main effect at low photon energies
• The probability of interaction increases with Z3
(Z: atomic number)
• High-Z materials are strong X Ray absorber
• Absorption increases markedly if g energy
increased from below to above K-shell energy
• Important K-edge energies
• 20Ca 4 keV - 53I 33 keV - 56Ba 37 keV - 82Pb 88 keV
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 Factors affecting Compton Effect
• At low energy, most of initial energy is
scattered
• ex : Es > 80% (h) if h <1 keV
• The probability of interaction decreases as h
increases
• Compton scattering process  1/E
• Increasing E  decreasing photon deviation
angle
• Mass attenuation coefficient  constant with Z
• effect proportional to the electron density in the
medium
•  small variation with atomic number (Z)
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 Attenuation

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 Attenuation coefficients

• Linear attenuation coeff. depends on :

• characteristics of the medium (density , Z)
• photon beam energy
• Mass attenuation coefficient :
 / [m2kg-1]
•  / same for water and water vapor
(different )
•  / similar for air and water (different µ

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 Attenuation of polychromatic beams

• Various energies  No more exponential

attenuation
• Progressive elimination of photons
through the matter
• Lower energies preferentially
• This effect is used in the design of filters
•  Beam hardening effect

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 HVL: Half Value Layer

• HVL: thickness reducing beam intensity by 50%

• Definition holds strictly for mono-energetic
beams
• Heterogeneous beam  hardening effect
• I/I0 = 1/2 = exp (-µ HVL) HVL = 0.693 / µ
• HVL depends on material and photon energy
• HVL characterizes spectrum or beam quality
•  modification of beam quality through
filtration
•  HVL (filtered beam)  HVL (beam before filter)
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 Radiological image formation

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 X Ray through human body: transmission

Images are based on the difference in TRANSMITTED photons

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 X Ray through human body

• Attenuation of an X Ray beam :

• air : negligible
• bone : significant due to relatively high density
(atom mass number of 40Ca)
• soft tissue (e.g. muscle,.. ) : similar to water
• fat tissue : less important than water
• lungs : weak due to low density (~1/3)
• bones can allow to visualize lung structures using higher kVp
(rib cage becomes relatively transparent by reducing
photoelectric effect; Compton prevails)
• body cavities are made visible by means of contrast products
(iodine, barium).

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 Importance of kV
60 kV - 50 mAs 70 kV - 50 mAs 80 kV - 50 mAs

Same mAs (time current product) value at different kV settings:

From “good” to “bad” picture
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 Low kV vs. high in high subject contrast

• The image contrast is

lowered
• Bones and lungs
structures can Low kV
simultaneously be
visualized

High kV

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 Enhancing contrast by contrast media

• Increase visibility soft tissues normally

transparent to X Rays
• Enhances the contrast within a specific
organ
• Can improve the image quality
• Main used substances
• Barium : abdominal parts
• Iodine : urography, angiography, etc.

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Based on absorption discontinuity at K-edge
100
X Ray ATTENUATION COEFFICIENT (cm2 g-1)

10

0.1 (keV)
20 30 40 50 60 70 80 90 100

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 Projection or plain radiography

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 Plain radiography

•Image: shadow of parts

absorbing or blocking X Rays
•Image is collected on
•Photosensitive film
•A digital imaging plate
•A fluoroscopic system
with cassette holder
•A “photographic negative”
•Darker regions have less
absorbed X Rays

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 Building the system

• Source X Ray tube

• Collimator
Collimator

Beam

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 Building the system

• Source X Ray tube

• Collimator
Collimator

• Patient Beam

• Absorbs and scatters

radiation
Soft
Airtissue
Patient
Bone

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 Building the system

• Source X Ray tube

• Collimator Collimator

• Patient Beam

• Absorbs and scatters

radiation
• Table Soft
• Absorbs and scatters Airtissue
Patient
Bone

radiation Table

• Antiscatter grid Grid

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 Building the system
• Source X Ray tube
• Collimator Collimator
• Patient
• Absorbs and scatters Beam
radiation
• Table
• Absorbs and scatters
radiation
• Antiscatter grid
Soft
Air tissue
Patient
• Intensifying screen and film in Bone

cassette Table

• AEC sensors Grid

AEC
Cassette

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 Special procedures: high & low kV

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 Low kV: mammography

• Radiography commonly 40-80 kV

• Low energy: PE dominant, max subject
contrast in soft tissue
• But: high attenuation, practical only for tissue
thickness of few cm
• Main application: breast imaging 20-30kV
• Anode material: Mo, Rh, (W)
• K-edge filtering: Mo (20kV) Rh (23.4kV)
• High resolution: focus 0.3 mm (0.1 magnifying)
• Specific tube orientation: tilted, thorax
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 High kV imaging

• kV of 100kV and up: specific advantages

• Used when different tissue types: bone, soft tissue,
Ba or I contrast materials
[image formation dependent on Compton]
• Give shorter exposure times, freezes motion 2
[intensity of Bremsstrahlung ~ (kV) ]
• Focal spot can be larger, since FFD up to 200cm
• BUT: more forward scatter, need for higher grid ratio
• Applications:
• Chest, obstetric pelvis, lumbar and dorsal
spine
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 What we learned on basic interactions and
plain radiography
• The basic interactions of photons for imaging
• Important: PE at low energy, Compton at high energy
• The use of contrast media and K-edge absorption
• The building blocks of a radiographic system
• Source
• Collimator
• Patient
• Table
• Anti-scatter grid
• Intensifying screen
• Film
• Low kV imaging: mammography
• High kV imaging: chest, spine,…
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International Atomic Energy Agency

Topic 3: Fluoroscopy
equipment

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 A “see-through” operation with motion

• Used to visualize motion of

internal fluid, structures
• Operator controls activation of
tube and position over patient
• Early fluoroscopy gave dim
image on fluorescent screen
• Physician seared in dark room
• Modern systems include
image intensifier with
television screen display and
choice of recording devices

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 Fluoroscopy

• X Ray transmitted trough patient

• The photographic plate replaced by fluorescent screen
• Screen fluoresces under irradiation and gives a life
picture
• Older systems direct viewing of screen
• Nowadays screen part of an Image Intensifier system
• Coupled to a television camera
• Radiologist can watch the images “live” on TV-monitor;
images can be recorded
• Fluoroscopy often used to observe digestive tract
• Upper GI series, Barium Swallow
• Lower GI series Barium Enema

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 Direct Fluoroscopy

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 Direct Fluoroscopy

In older fluoroscopic examinations radiologist stands

behind screen and view the picture
Radiologist receives high exposure; despite protective
glass, lead shielding in stand, apron and perhaps goggles
Main source to staff exposure is NOT the patient but the direct beam
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 Older Fluoroscopic Equipment
(still in use)

Staff in DIRECT beam

Even no protection
Radiologist should wear apron
and goggles
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 Direct fluoroscopy: protection staff

A system of mirrors
allows
The radiologist to
visualize without being Observers
eye
in direct beam

Lower staff dose

But still high patient

dose

Low efficiency screens

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 Direct fluoroscopy

• AVOID USE OF DIRECT FLUOROSCOPY

• Directive 97/43Euratom Art 8.4.

• In the case of fluoroscopy, examinations without an
image intensification or equivalent techniques are
not justified and shall therefore be prohibited.
• Direct fluoroscopy will not comply with BSS App.II.25
• “… performance of diagnostic radiography and
fluoroscopy equipment and of nuclear medicine
equipment should be assessed on the basis of
comparison with the guidance levels

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 The Image Intensifier System

(Developed from 1953 on)

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 Modern fluoroscopic system based on
Image Intensifier ( I I )

Display
control

Automatic control
display brightness
radiation dose
film exposure

Timer

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 Different fluoroscopic systems (1)

• Remote control systems

• Not requiring the presence
of medical specialists inside
the X Ray room
• Mobile C-arms
• Mostly used in surgical
theatres.

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 Different fluoroscopic systems (2)

• Interventional radiology systems

• Requiring specific safety
considerations.
Interventionalists can be near the
patient during the procedure.

• Multipurpose fluoroscopy systems

• They can be used as a remote control
system or as a system to perform
simple interventional procedures

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 The Image Intensifier

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 The Image Intensifier

I.I. Input Screen Electrode E1

Patient
Electrode E2
Electrode E3

I.I.Output Screen
Table
Grid
Photocathode
+

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 Image Intensifier Systems

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 Components of the I. I.

• Input screen: conversion of incident X Rays

into light photons (CsI)
• 1 X Ray photon creates  3,000 light photons
• Photocathode: conversion of light photons into
electrons
• only 10 to 20% of light photons are converted into
photoelectrons
• Electrodes : focalization of electrons onto the
output screen
• electrodes provide the electronic magnification
• Output screen: conversion of accelerated
electrons into light photons
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 Important Intensifier Characteristics (1)
• Conversion coefficient (Gx): the ratio of the output
screen brightness to the input screen dose rate
expressed in cd.m-2Gys-1
• Gx depends on the quality of the incident beam
• Minimum 3 mm Al. IEC publication 573 recommends 7mm )
• In interventional: higher filtration, Al or often Cu
• Gx is directly proportional to:
• the applied tube potential
• the diameter () of the input screen
• I.I. input screen () of 22 cm  Gx = 200
• I.I. input screen () of 16 cm  Gx = 200 x (16/22)2 = 105
• I.I. input screen () of 11 cm  Gx = 200 x (11/22)2 = 50

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 Important Intensifier Characteristics (2)
• Spatial resolution limit: the value of the highest
spatial frequency that can be visually detected
• it provides a sensitive measure of the state of
focusing of a system
• it is quoted by manufacturer and usually
measured optically and under fully
optimized conditions. This value
correlates well with the high frequency
limit of the Modulation Transfer Function
(MTF)
• it can be assessed by the Hüttner resolution pattern
which should contain several cycles at each
frequency in order to simulate the periodicity
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 Important Intensifier Characteristics (3)
• Brightness Uniformity: the input screen brightness may vary
from the center of the I.I. to the periphery

• Uniformity = (Brightness(c) - Brightness(p)) x 100 /

Brightness(c)

• Geometrical distortion:
(influence of surrounding
magnetic fields)

Pin-cushion S-distortion

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 Spatial resolution pattern

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 Multimodality: Optical Coupling
• Partially silvered beam-slitting
mirror
Video
camera • Distributes light to video
camera
Lens Aperture
• And other recording devices
• Circular aperture sets proper
light level to videocamera
Accessory
• Aperture small size increases
dose rate by ABC
port
• Aperture wide open lowers
dose rate but more noise is
apparent
• Accessory port for
Beam • spot film device,
splitting Output
• film changer,
mirror window • photospot camera,
• cine camera
• digital photospots.
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 Optical displaying systems

• conventional TV
• 262,5 or lines and 262,5 even lines
generating a full frame of 525 lines (in USA)
• 625 lines and 25 full frames/s up to 1000
lines (in Europe)
• interlaced mode is used to prevent flickering
• cinema
• 35 mm film format: from 25 to 150 images/s
• photography
• rolled film of 105 mm: max 6 images/s
• film of 100 mm x 100 mm
• …
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International Atomic Energy Agency
 Digital Image recording
• In newer fluoroscopic systems film recording
replaced with digital image recording.
• Digital photospots acquired by recording a
digitized video signal and storing it in
computer memory.
• Operation fast, convenient
• Image quality can be enhanced by application
of various image processing techniques,
including window-level, frame averaging, and
edge enhancement.
• But, the spatial resolution of digital photospots
is less than that of film images.
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 Digital Subtraction Angiography

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 DSA

Digital: allows subtraction, image manipulation

Two images with different calculation algorithms

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 DSA

• Technique to produce images of vessels

isolated from overlying structures
• A first image is taken: the MASK (M), before injection
of a contrast agent
• A second image: the CONTRAST IMAGE ( C ),
containing the contrast agent
• When mask is subtracted from contrast image:
remains contrast agent in vessels and
movement artifacts, free of surrounding
anatomy:
• Difference image D=C-M

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 DSA system (1)

Basic DSA system: logarithmic amplifier and ADC brings

video signal to the dual memory circuits before subtracting;
some postprocessing can be done on the difference image

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 DSA system (2)

• Logarithmic subtraction:
• To ensure that artery of uniform diameter in
region of changing thickness appears with
uniform contrast in D difference image

ID =log IC-log IM = -(µMxM+µVxV) - (-µMxM) = -µVxV

• Without logarithmic amplification

I D = I C - I M= e -e
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 Digital fluoroscopy and patient dose

• Digital fluoroscopy systems employ extra filtration to

reduce dose and enhance image quality
• Copper: 0.1 - 0.3 mm Cu
• General angiography I I entrance dose: ~1 µGy/s
• DSA needs higher dose rate (contrast subs): 1.5-5µGy/s
• Dose rates increase when field size decreases
• Digital is more sensitive than cine-film: significant dose
rate possible

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 Specificity of Interventional radiology

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 Introduction to IR

• Interventional radiology comprises

fluoroscopically guided therapeutic and
diagnostic techniques.
• They are complex procedures requiring
specially designed equipment, and involving
high exposures to both personnel and patients.
• Good knowledge of equipment specification
and characteristics is essential for an effective
optimization of radiation protection

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 IR Procedures

IR procedures may be classified into:

• cardiac (cardiologists), non cardiac (radiologists)
• vascular, non vascular
VASCULAR PROCEDURES:
EMBOLIZATION
DRUG INFUSION (Tumor catheter placement),
ANGIOPLASTY (PTA, Atherectomy, stent graft placement),
CARDIAC INTERVENTION (PTCA, radiofrequency ablation)
TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT
NON-VASCULAR PROCEDURES:
DRAINAGE & PUNCTURE
PERCUTANEOUS NEEDLE BIOPSY
STENT PLACEMENT
COAGULATION THERAPY
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 Requirements on equipment for IR

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 I R :Requirements to the equipment

HOW MUST BE AN X Ray SYSTEM

"SPECIFICALLY DESIGNED" FOR
INTERVENTIONAL RADIOLOGY?

“Constant potential” (HF) generator

Arc system (X Ray tube down)
High efficiency intensifier
Easy operational controls
Good image saving and retrieving
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 Requirements for equipment
(Joint WHO/IRH/CE workshop 1995)
RECOMMENDED TECHNICAL SPECIFICATION (1) :

• Use of audible dose or dose rate alarms is not

considered appropriate (cause of confusion)
• Dose and image quality : user selectable variables
• Additional filtration
• Removable Grid
• Pulsed fluoroscopy modes
• Image hold system
• Flexibility for AEC (IMAGE or DOSE weighted)
• Recursive or temporal filtering: temporal
averaging in fluoroscopy (dose reduction,
improvement of SNR)
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 Requirements for equipment
(Joint WHO/IRH/CE workshop 1995)
RECOMMENDED TECHNICAL SPECIFICATION (2) :

• Roadmapping (use of a reference image on which

the current image is overlayed)
* Image simulation (impact of changes in technique
factors displayed prospectively, effect of
semitransparent filters simulated)
* Region of Interest (ROI) fluoroscopy: a low noise
image in the centre is presented surrounded by a
low dose (noisy) region.
* provision of additional shielding to optimize
occupational protection:, etc.
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 Requirements for Image Intensifier
(Joint WHO/IRH/CE workshop 1995)
• Cardiology: 25 cm; max. dose rate : 0.6 µGy/s
• Neuroradiology: 30 cm; max. dose rate : 0.6 µGy/s
• Peripheral vascular: 35-40 cm; max. dose rate : 0.2 µGy/s
Note : dose rate in normal mode, should be measured at the
entrance surface of Image Intensifier
• 2 x magnification available
• low dose rate and boost modes available
• Manual selection of the AEC
• Operational design of the AEC must be specified

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 What we learned about fluoroscopy
equipment
• Fluoroscopy is visualization and recording of moving
structures in the body
• Direct fluoroscopy is to be proscribed
• The image intensifier amplifies electronically an
radiographic image
• We learned about the characteristics of the I I
• Different fluoroscopic systems are used for different
procedures
• Digital systems make vessels clearly visible by
subtraction (DSA)
• Interventional radiology has specific stringent
requirements on the equipment

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