FLUOROSCOPY

X-RAYS IN MOTION
“Viewing dynamic studies
of the human body”
HISTORY

• Thomas Edison, 1896

• Screen (zinc-cadmium sulfide)
placed over patient’s body in x-ray
beam
• Radiologist looked directly at screen
• Red goggles-30 minutes before exam
• 1950 image intensifiers developed
PRESENTLY….
• Fluoro viewed at same level of
brightness as radiographs (100-100
lux)
• X-ray tube under table/over table or
in c-arm
• Image intensifier above patient in
carriage
• Carriage also has the power drive
control, spot film selection and tube
shutters
RED GOGGLES?
The eye

• Light passes thru the cornea

• Between the cornea and lens is
iris
• Iris acts as a diaphragm
• Contracts in bright, dilates in
dark
• Light hits lens which focuses
the light onto the retina where
the cones and rods await
• Cones- central
• Rods - periphery
RODS CONES
• Sensitive to low • Less sensitive to
light light (threshold of
• Used in night vision 100 lux)
(scotopic vision) • Will respond to
• Dims objects seen bright light
better peripherally • Daylight vision
• Color blind (phototopic vision)
• Do not perceive • Perceive color,
detail differences in
brightness
• Perceive fine detail
IN FLUOROSCOPY

• The winner is……

• CONES!!
FLUORO X-RAY TUBES
• Operate at .5 to 5mA. Why do they operate
at such low mA stations?
• They are designed to operate for a longer
period of time with higher kVp for longer
scale contrast.
• kVp dependent on body section
• kVp and mA can be controlled to select
image brightness
• Maintaining (automatic) of the brightness
us called ABC or ABS or AGC
(control,stabilization gain control)
Fluoro X-ray Tubes

• Fixed…may be mounted no
closer than 15 inches or 38 cm
to patient
• Mobile may be brought no
closer than 12 inches or 30 cm
to patient
IMAGE INTENSIFIER
RECEIVE REMNANT X-
RAY BEAM, CONVERT IT
TO LIGHT…INCREASE
THE LIGHT INTENSITY
5000-30,000 TIMES
THE SEQUENCE

• Beam exits the patient

• Hits the input
phosphore(cesium iodide CsI
tightly packed needles…
produce excellent spatial
resolution)
• Converts x-rays to visible light
The sequence cont.

• Hits photocathode (Cesium and

antimony components)
• Emits electrons when struck by
light (photoemission)
The sequence cont

• The potential difference within the

image intensifier tube is a constant
25,000 volts
• Electrons are accelerated to anode
• Anode is a circular plate with hole
for electrons to go thru.
• Hits output phosphor which interact
with electrons and produce light
The Electron Path

• MUST BE FOCUSED FOR ACCURATE

IMAGE PATTERN
• Electrostatic lenses (focusing
devices)
• Accelerate and focus electron beam
• “The engineering aspect of
maintaining proper electron travel is
called electron optics”
Continuing the
sequence
• Electrons hit output phosphor
(zinc cadmium sulfide) with high
kinetic energy producing an
increased amount of light
• Each photoelectron at the
output phosphor has 50-75 more
light photons
FLUX GAIN

• Ratio of number of light

photons at the output
phosphor to the number of x-
rays at the input phosphor
• Flux gain =
# of output light photon
# of input x-ray photons
MINIFICATION GAIN
• Ratio of the square of • Try the math
the diameter of the • 6 inches squared = 36
input phosphor to the 1 inch squared =1
•
square of the diameter
of the output phosphor • Minification gain = 36
OR
• # of electrons
produces at large input
screen ( 6 inches)
squared, compressed
into the area of small
output screen ( 1 inch)
squared
 BRIGHTNESS GAIN
• Minification gain x flux gain
• Increases illumination level of an image
• Ratio of the intensity of the illumination ot
the output phosphor to the radiation
intensity at the input phosphor
• Brightness gain of 5000-30,000
• Maintaining (automatic) of the brightness
us called ABC or ABS or AGC
(control,stabilization gain control)
CONVERSION FACTOR

• Ratio of intensity of illumination

at the output phosphor
(measured in Candela per meter
squared) to the radiation
intensity at the input phosphor
(mR per sec)
• Cd/mr squared
mr/s
MULTIFIELD IMAGE
INTENSIFICATION

Allows focal point change

to reduce field of view and
magnify the image
Some facts about
multifield image
intensifiers
• Standard component on most
machines
• Always built in in digital units
• Most popular is 25/17
• Trifield tubes are 25/17/12 or
23/15/10
MULTIFIELD IMAGE
INTENSIFICATION
• Numeric dimensions refer to the
input phosphor (25/17)
• Smaller dimension (25/17)
17 result
in magnified images
• At 25-all photoelectrons are
accelerated to output phosphor
MULTIFIELD IMAGE
INTENSIFICATION
• Smaller dimension – voltage of
focusing lenses is increased
• Electron focal spot moves away
from the output.
• Only the electrons from the
center of input strike the output
PROS CONS
• Only central • Minification gain
region of input is is reduced =
used dimmer image
• Spatial • To compensate
resolution is must increase
better (think of mA
it as the umbra!) • Increase patient
• Lower noise, dose
higher contrast
resolution
VIGNETTING:

REDUCTION OF
PERIPHERAL
BRIGHTNESS
COMING SOON
• Coupling (Vidicon, Plumbicon)
• Fiber Optics
• Lens coupling
• Beam splitting
• Modulation
• Size of the video signal directly
proportion to the light intensity
received by x-ray tube. The signal
received by the TV tube is
modulated
Image recording

• Cassette loaded spot film

• When recording image, the
radiographic mA goes from a low
mA to high mA. Why?
• Photospot camera
• Patient dose increases with size
of film
DIGITAL FLUOROSCOPY

• Bushong, Chapter 27 pgs 437-

441
• Reference: Chapter 12, Fauber
pg 302-303 to include figure 12-
6
QUESTION

Why is it easy to convert a

conventional fluoro unit to
a digital one?
Facts about digital
fluoro
• Image acquisition is faster
• Can post process
• Similar equipment to a
conventional fluoro room except
• two monitors
• Operates in radiographic mode
DF and radiographic
mode
• Hundreds of mA vs 5 mA
• Due to the high generator
required for DF
• the x-ray beam is pulsed
progressive fluoroscopy
PULSED PROGRESSIVE
FLUOROSCOPY
• Generator can be switched on and
off rapidly
• Interrogation time
• Tube switched on and meets selected
levels of kVp and mA
• Extinction time
• Time required for the tube to be
switched off
• Each must have times of less than
one 1 ms.
 CCD

• Instead of a vidicom or
plumbicom (see figure 27-8, pg
440 Bushong)
• Discuss Box 27-1 on pg 441