Fluoroscopy

• It is an x-ray imaging procedure that allows real

time imaging of a patient with high temporal
resolution.
• Allows continuous viewing of a time varying x-ray
image and permits live visual evaluation of
dynamic events.
• Uses TV technology which provides 30 frames per
second imaging.
• Allows acquisition of a real time digital sequence
of images (digital video) that can be played back
as a movie loop
• Fluoroscopy uses continuous X-ray imaging,
• The image output of a fluoroscopic imaging system is a
projection radiographic image, but in a typical 10-minute
fluoroscopic procedure a total of 18,000 individual images
are produced.
• fluoroscopy is used
• to monitor interventional surgery,
 for the placement of catheters, guide-wires and
pacemakers in cardiac
 catheterization laboratories,
• for dynamic studies of the GI tract and cardiovascular
system using contrast agents.
 Image intensifier (II)
• The principal component of the imaging chain
that distinguishes fluoroscopy from
radiography is the image intensifier.
• Image intensifiers are used to convert the x-
ray spectrum to light energy.
• The fluoroscopy image intensifiers are several
thousand more sensitive than the screen-film
cassette image intensifiers.
The input screen
 The input screen
• X-rays must pass through the vacuum window
and support, before striking the cesium iodide
(Csl) input phosphor.
• CsI forms in long crystalline needles that act like
light pipes, limiting the lateral spread of light and
preserving spatial resolution.
 It absorb the x-rays and convert their energy
into visible light.
• Light strikes the photocathode causing electrons
to be liberated into the electronic lens system of
the II.
 Electron optics
• The five-component ("pentode") electronic lens system of
the II.
 The G1, G2, and G3 electrodes
 The input screen substrate (the cathode)
 The anode near the output phosphor
• under the influence of the ~25,000 to 35,000 V electric
field, electrons are accelerated and arrive at the anode
with high velocity and considerable kinetic energy.
• The intermediate electrodes (G1, G2, and G3) shape the
electric field, focusing the electrons properly onto the
output layer.
• After penetrating the very thin anode, the energetic
electrons strike the output phosphor and cause a burst of
light to be emitted.
 The output phosphor
• The electrons strike the output phosphor,
causing emission of light.
• The thick glass output window allows light to
escape the top of II.
• Light that is reflected in the output window is
scavenged to reduce glare by the addition of a
light absorber around the circumference of
the output window.
 The output phosphor
• Each electron causes the emission of
approximately 1,000 light photons from the
output phosphor.
• The image is much smaller at the output
phosphor than it is at the input phosphor,
because the 23- to 35-cm diameter input image is
focused onto a circle with a 2.5-cm diameter.
• The reduction in image diameter leads to
amplification (minification)
 Characteristics of II Performance
• Parameters that are useful in specifying the
capabilities of the II,
Conversion factor
Brightness gain
• These characteristics are useful in
troubleshooting lIs when they are not
performing properly
 Conversion factor
• Defined as a measure of the gain of an II
•

• 100 to 200 for new II

• Degrades over time, ultimately can lead to II
replacement
• The conversion factor is the proper quantity
for expressing image intensification.
 Brightness gain (BG)
• It is the product of the electronic and
minification gains of the II.
• T he electronic gain of an II is roughly about 50,
and the minification gain changes depending on
the size of the input phosphor and the

• As the effective diameter of the input phosphor

decreases (increasing magnification), the
brightness gain decreases
 Automatic Brightness Control
• The purpose of ABC is to keep the brightness
of the image constant at monitor.
By regulating the x-ray exposure rate
(control kVp, mA or both)
• ABC triggers with changing patient size and
field modes.
Fluoroscopic Data Acquisition-image
Intensified System
Video Camera
 The television camera
• The television camera consists of cylindrical
housing, approximately 15 mm in diameter by
25 cm in length, that contains the heart of the
television camera tube.
• It also contains electromagnetic coils that are
used to properly steer the electron beam
inside the tube.
 The television camera
• At the TV camera , an electron beam is swept
in raster fashion on the TV target.
• The TV target is a photoconductor, whose
electrical resistance is modulated by varying
levels of light intensity.
• In areas of more light, more of the electrons in
the electron beam pass across the TV target
and reach the signal plate, producing a higher
video signal in those lighter reasons.
 Flat panel digital fluoroscopy
• Flat pane devices are thin film transistor (TFT)
pixelated arrays that are rectangular in format
and are used as x-ray detectors.
• CsI scintillator is used to convert the incident
x-ray beam into light.
• TFT systems have a photodiode at each
detector element which converts the light
energy to electronic signal
 Flat panel digital fluoroscopy
• Flat panel detectors replace the image intensifier, video
camera and directly records the real-time fluoroscopic
image sequence.
• The image produced by the image intensifier is circular
in format, resulting in less efficient utilization of
rectangular monitors for fluoroscopic display.
• The flat panel detector produces a rectangular image,
well matched to the rectangular format of TV monitors.
• The flat panel detector is substantially less bulky than
the image intensifier and TV system, but provides the
same functionality.