FLOUROSCOPY AND IITV

system

MODERATOR
MODERATOR
MR.
MR.S.C.BANSAL
S.C.BANSAL

Moderator:
Moderator:
Presenter:
Presenter: Mr.
Mr.S.
S.C.
C.Bansal
Bansal((Lecturer)
Lecturer)
Kriti
KritiKapur.
Kapur. Deptt.
Deptt.Of
OfRadio-Diagnosis
Radio-Diagnosis&&
Deptt.
Deptt.Of
OfRadio-Diagnosis
Radio-Diagnosis&& Imaging.
Imaging.
Imaging.
Imaging. PGIMER,
PGIMER,Chandigarh-160012
Chandigarh-160012
PGIMER,
PGIMER,Chandigarh-160012
Chandigarh-160012
1
 DEFINITIONS
 Luminescence: Materials which change invisible
radiation to luminous radiation are known as
phosphors and this effect is known as
luminescence.
 Fluorescence: It is the phenomenon of emission of
light through a substance when irradiated.
 Fluorescent material: It is a material that is
luminous only so long as it is irradiated.
 Phosphorescent material: It is a substance that
continues to emit light for a period after the
stimulating material has been removed.
2
 The German Physicist WC Roentgen
Introduction: discovered x-ray in 1895 because of
their ability to cause fluorescence and
the first X-ray image of human body
part was observed fluoroscopically by
Dr. Glasser after the invention of x-rays.
After 1896 inventor Thomas A Edison
created the fluoroscope consisting of
ZNCdS screen

3
 Definition: Fluoroscopy is an important diagnostic and
interventional imaging tool that enables us to view
dynamic real time images of anatomy and function
unmatched by other imaging techniques.

 Basic principles of fluoroscopy: The term of

fluoroscopy implies the use of a florescent screen, which
fluoresces when continuous beam of x-ray strike on it
when a patient is placed between a source of x-rays and
this screen. The x-ray image becomes a visible light
image and can be observed directly or by television
fluoroscopy (IITV) system

4
 Fluoroscopy
 The advantages of the procedure are speed and ease
that makes possible the study of movement. A
radiologist can watch and elucidate any dynamic
function as it occurs, such as swallowing, breathing
and opening and closing of valves of the heart.
Furthermore, during exam a patient can be moved
into various positions in order to determine the one
which will best show a particular abnormality, e.g.
the profile projection of an ulcer situated somewhere
on the posterior wall of the stomach.
 However, fluoroscopy should not be employed except
to obtain clinical information which otherwise is
unobtainable. This is because of greater radiation
dose to the patient from fluoroscopy than from direct
radiography.
5
 To perform fluoroscopy the bare
essentials are an Xray tube, a patient and
a fluorescent screen, together with some
means of arranging and supporting the
three in appropriate relationship to each
other. Rest of other parts are designed
either to protect the patient and the
operator from stray radiation or to facilitate
the performance of an examination.
 In radiographic practice, two forms of
fluoroscopy are recognized: Direct
fluoroscopy (Dark Room Fluoroscopy) and
Intensifier Fluoroscopy / Television
Fluoroscopy.

6
 Direct Fluoroscopy
• In direct fluoroscopy, the operator
faces the fluorescent screen itself
and makes immediate observations of
the images created on the screen by
the attenuation of the X-ray beam by
the patient.

7
 The structure of
fluoroscopic screen:
• The structure of a screen for direct fluoroscopy
is comparatively simple. The phosphor is coated
upon an underlying stratum of white pigment,
placed on a suitably prepared and finished sheet
of cardboard. Paxolin is attached behind the
cardboard base for mechanical strength. Over
the front of screen must be put a piece of lead
glass of which the purpose is to prevent
irradiation of an observer by primary radiation.

8
Direct fluoroscopy

Lead glass
Lead glass

Image on
Image on
Flourescent
X ray Flourescent
X ray
tube body
body
screen
screen
tube

ZnCdS
ZnCdS

Lead sheets (.5 mm)

Lead sheets (.5 mm)
9
 DISADVANTAGES:
Less brighter image
More radiation dose to patient and viewer
Wear red goggles for upto 20-30 min to adapt eye to darkness
Lack of sharpness
Dark adaptation is required
Because of these reasons, in 1950’s the image intensifier were
developed which allows the use of cone vision (photopic vision)

10
Components
Components of
of fluoroscope
fluoroscope
Fluoroscopy
Fluoroscopyx-ray
x-raytube
tube
X-ray
X-raygenerator
generator
Fluoroscopy
Fluoroscopytable
table
Spot
Spotfilm
filmdevice
device

11
12
Fluoroscopy
Fluoroscopyx-ray
x-raytube
tube

• Standard rotating anode tube

• Same as used for radiography but it is operated at
much lower tube current
• Tube current 0.5 to 5 mA compared to 100 to 1000
mA for conventional radiographic tubes
• Tube is equipped with shutters (an x-ray collimator)
which is electrically driven.
• Permanent filtration 2.5 mm of Al Equivalent.

13
X-ray
X-ray generators
generators
Different
Differenttypes
types(3
(3phase
phase66pulse
pulseor
or33phase
phase12
12
pulse
pulsegenerally
generallyused)
used)or
orhigh
highfrequency
frequency
generator
generatorwith
withpower
powerrating
ratingof
of80
80to
to100
100kw
kwisis
used.
used.
The
Theprinciple
principlefunction
functionof
ofgenerator
generatorisisto
to
provide
providerepeatable
repeatableexposure
exposure
Minimum
Minimumexposure time
exposuretime 0.01
0.01to
to0.001
0.001
seconds
seconds
14
Fluorescent screen

PROTECTIVE
PROTECTIVELAYER
LAYER(cellulose
(cellulose
compounds)
compounds)
PHOSPHOR
PHOSPHORININPLASTIC
PLASTICZnCdS
ZnCdS
REFLECTING
REFLECTINGLAYER
LAYER(TiO2)
(TiO2)
PLASTIC
PLASTICBASE
BASE

15
 Fluoroscopic
Fluoroscopic table
table

• Now a days standard conventional

pattern is followed in which x-ray
tube lies beneath the table and
intensifying screen above

16
• Material of table is radioparent (e.g. laminated
paper base backelite/ carbon fibre)
• It has got flotting movement
• Tilting can be -
• 90°-0°-90° (Myelography)
• 90°-0°-55° (Myelography)
• 90°-0°-15° (for G.E. studies)

17
 Dimensions:
 Length: 74 to 90”
 Height : 32 to 34.5”
 Width : 28 to 29”
These
dimensions vary from model to model

18
 Spot
Spotfilm
filmdevice
device//serial
serialchanger/
changer/
exploratory
exploratorychanger
changer

• The purpose of spot film device is to allow films of fluoroscopic

appearances to be exposed quickly
• They do not require shutter, since, exposure can be controlled
simply by the rapid switching of the x-ray generator
• This is capable of recording images at the rate of one image
per second (single shot) or a rapid sequence of up to 12
images per second

19
20
 Intensifier Fluoroscopy
 In intensifier fluoroscopy, it involves an
image intensifier tube and associated
equipment which electrically and optically
processes the immediate fluorescent
image in order to brighten it.
 The brightened image may or may not
finally be viewed by means of closed
circuit television and necessarily is
transmitted through an optical system.
21
 Image
Imageintensifier
intensifier
•Image intensifier is a device which increase image
brightness without forcing increased radiation
exposure by converting the transmitted x-ray into a
brightened visible light image.
• Image Intensification : It is a process of
brightening the image during the fluoroscopy.

22
Components of image
intensifier
1. Input phosphor
2. Photocathode
3. Electrostatic focusing lens
4. Accelerating anode
5. Output phosphor
6. Enclosure

23
24
Input phosphor
 Earlier first generation II  silver activated ZnCdS crystals
(ZnCdS:Ag)
 Second generation – Na activated CSI
 Diameter  25-57 cm
 Exposure of the input phosphor to the x-ray beam that has been
transmitted through the patient causes it to emit light
 The brightness of light emitted is proportional to the intensity of the
incident x-ray

25
 Advantage of CsI over ZnCdS
CsI input phoshor Image Intensifier have better image
quality than ZnCdS screens in two ways.
 Greater packing density of CsI as it can be vacuum deposited,
requires no inert binder. Packing density is 3 times more than
ZnCdS so thickness of phosphor layer is reduced from 0.3mm to
0.1 mm with CsI resulting into improved resolution.
 More favorable effective atomic number of CsI with cesium
atomic number 55 (K shell absorption – 36.0 KeV) and Iodine
atomic number 53 (K Shell absorption – 33.2 KeV). Means CsI
input phosphor absorb approx. 2/3 rd of incident photons
compared to 1/3rd for ZnCdS. As most adult fluoroscopy is done
at peak energy of 80 -100KvP with mean energy of 33-40KeV.

26
 Photo Cathode
•Coated onto the input phosphor
•Is a photoemission metal usually combination of CS and
Antimony
•When light from the fluorescent screen strikes the
photocathode it emits e-ns in no: proportional to the
brightness of the screen.
•It also serves as cathode of the image tube. It is usually
kept at ground potential
Photocathode should be kept vary close to input phosphor
otherwise the light will spread before reaches to
photocathode and will result in blurring the image.
27
 Electronic focusing lens

•This is made up of a series of positive charged electrodes that

are usually plated onto the inside surface of the glass envelope
•It provides velocity and direction of an e- beam.
•These electrodes focus the e- beam as it flows from the
photocathode towards the output phosphor
• The image on the output phosphor is reduced in size due to
which it is brighter .

28
•It is located in the neck of the image tube

•Its to draw e-ns from the photocathode and accelerate

them towards the output phosphor

•The anode has a potential of 25-35 KV

29
•Made up of ZnCdS: Ag as activator .
•Diameter  2.5 -3.5 cm
•Because of e-ns are greatly accelerated (potential
difference 25-35 kv) they emit more light photon (9000
times brighter than input phosphor)

30
•The
•TheHighly
Highlyevacuated
evacuatedglass
glassenvelope
envelopeabout
about22mm
mmthick
thick
•glass
•glasstube
tubeisisagain
againenclosed
enclosedininPb
Pblined
linedmetal
metalcontainer
container
•The
•Thepurpose
purposeofofthis
thisshield
shieldisistotoprovide
providemechanical,
mechanical,anti
antimagnetic
magnetic
and
andradiation
radiationprotection
protection
•Over
•Overthe
theoutput
outputphosphor
phosphorthere
thereisisaalead
leadglass
glasswindow
windowwhich
which
absorbs
absorbsradiation
radiationthat
thatpasses
passesthrough
throughthe theintensifier
intensifier
•The
•Thehousing
housingmust
mustbebelight
lightproof
proof&&air
airtight because
tight ––because 
•Moisture
•Moisturecould
couldresult
resultininsparking
sparking
•Dust
•Dustwould
wouldbe
beattracted
attractedby
byelectrostatic
electrostaticforces
forcestotothe
theviewing
viewing 31

face
Brightness
Brightnessgain
gain: :The
Thebrightness
brightnessgain
gainofofan
animage
imageintensifier
intensifiercomes
comes
from
fromtwo
twocompletely
completelyunrelated
unrelatedsources
sourcescalled
called
•Minification
•Minificationgain
gain
•Flux
•Fluxgain
gain
Minification gain : Produced by a reduction in image size
The quantity of gain depends upon relative areas of the input screens and i
is expressed in terms of diameter
Minification gain = (D1/D2)²
Where D1 = dia. of input screen
D2 = dia. Of output screen
32
•Flux gain increases the brightness of the fluoroscopic image by a
factor of approx 50.

•For each light photon from the input screen, 50 light photons are
emitted by the output screen

•The total brightness gain of an image intensifier is the product of the

minification and flux gains

•Brightness gain = Minification gain x flux gain

33
 Dual field / Triple field II

 It means II can be operated in several

modes including 4.5”, 6”, 9” or 14” mode.
The 9” mode is used to view large
anatomic areas, when size is
unimportant, the 4.5 “ or 6” mode is used
for their better quality image.
 Field size is changed by applying a single
electronic principle i.e., the higher the
voltage on the electrostatic focusing lens.
The more the electron beam is focused.
34
 Dual Mode II
 If in 9” mode the electrostatic focusing
voltage is decreased, the electrons
focus to a point or cross, close to the
output phosphor and final image is
actually smaller than the phosphor.
 In 6” mode the electron focusing
voltage is increased and electron focus
further away from the output phosphor.
After the electrons cross, they diverge,
so the image on the output phosphor is
larger than it is in the 9”mode.
Exposure factors are automatically
increased when the unit is used in 6”
mode to compensate for the decreased
brightness from minification gain.
35
 X-ray

Absorb x-ray photons Patient

Input phosphor

Convert energy into

X-RAYS light phosphor
X-RAYS
Strikes Photocathode layer
(SbCs3)

Emits Photoelectrons Drawn away from photocathode by high PD

Accelerate to Anode

Series of electrostatic
focusing lens
Guide the
Output phosphor
e-n beam
Light photon

Fluoroscopic imag

36
•The output phosphor of the image intensifier tube has a diameter about
2.5 cm and this of course is much too small for an observer to appreciate
detail by looking at it directly so to see the image a magnifying optical
system is necessary at the output phosphor before the image can be
viewed

The image can be viewed by 2 methods

Direct method Indirect system 37

(IITV system)
In this we can see the image directly through a series of lenses and
mirrors
Disadvantages:
•Only one person can see the image at a time
•Considerable loss of photon (loss of image)
•Small viewing angle
•It restrict the movement during procedure.

38
39
•In this system a TV camera is attached to the optical system of output
phosphor.
•A video signal is given to the TV monitor which displays the image
•This system is also known as IITV system
•This is the modern system and it has following advantages:
•Any number of people can study the image at the same time
•Monitor can be placed not only in the fluoroscopic room but
anywhere in the department it may be in 1.Reporting rooms .
2.Ot
3.In work shops . 40
 Image intensifier close circuit
television system (IITV)

•The fluoroscopic TV system are always

closed circuit systems i.e. the video
signal is transmitted from one component
to the next through cables rather than
through the air, as in broadcast television

41
 Output
phosphor

Convey

Fluoroscopic
image

Video
camera
Converted into a series
of electrical pulses
Video signal
Transmitted
through cable

Camera control
unit

amplified and
forwarded
TV monitor 42
TV
TVCAMERA
CAMERATUBE TUBE
Works
Workson
onaaprinciple
principleeither
eitherofof
photoconductivity
photoconductivityororphotoemission
photoemission
TYPES
TYPESOF
OFCAMERA
CAMERATUBE
TUBE

•Othicon
•Othicontube
tube
•Vidicon
•Vidicontube
tube
•Plumbicon
•Plumbicontube
tube
•Isocone
•Isoconetube
tubeand
and
•Digital
•Digitalcharged
chargedcouple
coupledevice
devicecamera
camera(CCD).
(CCD).
43
OTHICON
OTHICONTUBE TUBE
•First
•Firstcamera
cameratube
tube
•Large
•Largesize
size
•Complex
•Complexandand
•Robustness
•Robustness
VIDICON
VIDICONTUBETUBE
•Commonly
•Commonlyused
usednow nowaadays
days
•Compactness
•Compactnessororlight
lightininweight
weight
•Relatively
•Relativelyinexpensive
inexpensivethan
thanother
othersimplicity
simplicity
•Robustness
•Robustness
PLUMBICON
PLUMBICONAND ANDISOCONE
ISOCONETUBETUBE
•It’s
•It’saatype
typeofofvidicon
vidiconcamera
cameratube
tube
•Better
•Betterthan
thanthe
thevidicon
vidicontube
tubebut
butthey
theyare
arevery
verycostlier
costlier 44
•Diameter
•Diameter11inch
inch
•Length
•Length66inch
inch
•Main
•Mainparts
parts--
•Target
•Targetsection
section
•Electron
•Electrongun
gun
•Electromagnetic
•Electromagneticfocusing
focusingcoil
coil
•Two
•Twopair
pairofofelectrostatic
electrostatic
deflecting
deflectingcoil
coil
•A
•Ascanning
scanningsection
section 45
46
 WORKING PRINCIPLE OF VIDICON
CAMERA AND HOW VIDEO SIGNAL
IS OBTAINED
Globule absorbs light

emitting

Photoelectrons Attract Anode

Removed from tube

Globule becomes +ve change

Behave like tiny capacitor

Current onto conductive signal plate

Charged globules stores an electrical image

E-beem scan Image &
emitted photoelectro ns

Discharging of tiny globule capacitors

Electron from the Scan

beam neutralize
+ve charge in the globules

Contd… 47
Electron on signal
Plate
Leave the plate via resistor

Form Current
through a resistor
Voltage appears & collected for

each neutralized globules

VIDEO SIGNAL

48
Working principle of T.V monitor
Control Grid
Receive Video signal from ccu & regulate

No. of e-ns & the brightness of

individual dots

Grid allows large no. of e-ns to reach the f. screen

Produce bright area in the TV

Picture

Grid cuts off the e-ns flow almost completely

Dark Area

E-ns is Accelerated

Strikes the fluorescent Screen

Emits large no. of light photons

VISIBLE TV IMAGE

49
SCANNING SECTION/ SYSTEMS
 In the scanning section of tube, externally mounted
coil (emitting focusing coil and electrostatic deflecting
coil) produce an axial electromagnetic field by means
of which-
• The electrons are focused on the target of tube
and
• The beam is moved over the target area in an
orderly scanning scan
 Two types scanning system
• Sequential scanning pattern and
• Interlaced scanning pattern 50
 SEQUENTIAL SCANNING
PATTERN
 Also called
progressive scanning

Disadvantages
 Technical
 Requires a wide frequency band during transmission
51
 Interlaced scanning

• Instead of scanning all 625 line

consequently, only the even no. of lines are
scanned during the first half of the frame
and only the odd no. lines are scanned
during second half.

• In this pattern the transmission is easier

and cheaper because the actual picture
frequency is lower
52
TELEVISION IMAGE QUALITY
 The assessment of the quality of TV images is
a complex subject but there are a no. of image
characteristics relating specifically to TV
system

• Resolution
• Contrast
• Brightness
• Image lag
• Distortion

53
 Resolution
Resolution
• Resolution is the process by which something is separated into its
component part
• The resolution of imaging system refers to the amount of detail
which is observable
• It may be formulated as the number of pairs of black and white lines
which an image forming or image recording device can demonstrate
in a length of 1 mm
• Vertical resolution is determined by no. of vertical scan lines (e.g.
625).
• In recent years the manufactures of radio diagnostic imaging
equipment have developed his definition TV system which employ
1249 or even more lines.
• The horizontal resolution of TV system is determined BY its band
pass or bandwidth
• Band pass must be able to transmit sufficient information to produce
this resolution
• Band pass of TV system varies from 5 MHz to 20 MHz.

54
 Contrast
Contrast
• The contrast of the image on a TV screen clearly
depends on the contrast of the original image
focused onto the signal plate of the pick up tube.
• Both camera and monitor affect the contrast of a TV
image.
• A vidicon camera reduces contrast by a factor of
approx. 0.8 and the monitor enhances by a factor of
2.

55
 Brightness
Brightness
• The term luminance and brightness are often used
when discussing the aspect of TV image
• Luminance can be defined as light emitted per unit
area from a surface. It is measured in candela per
square meter (Cd/m2)

Automatic
Automatic brightness
brightness control
control (ABC)
(ABC)
•ABC helps to maintain the image intensifier exposure
•ABC helps to maintain the image intensifier exposure
rate
ratebased
basedononthethesubject’s
subject’sthickness
thickness
•It
•Itisiscritical
critical totothe
thepatient
patientdose
doseand
andimage
imagequality
quality

56
• The ABC monitors the light output from an area of the
face of the image intensifier and it tries to maintain
the signal travel within an approximate range of that
output and adjust tube potential (kvp) and tube
current (mA) a/c to predefined algorithm
• It refers to control of x-ray exposure levels
Automatic gain control (AGC)
• If brightness is controlled by varying sensitivity of the
TV system the term AGC is used.
• It is fairly simple and inexpensive way to control
image brightness
• It does not change the x-ray dose rate to the patient

57
 Artifacts
 Lag
 Vignetting,
 Veiling glare
 Pincushion distortion
 S distortion.

58
 Lag
 Lag is the persistence of luminescence
after x-ray stimulation has been terminated.
 Lag degrades the temporal resolution of
the dynamic image.
 Older image intensifier tubes had
phosphors with lag times on the order of 30–
40 msec. Current image intensifier tubes
have lag times of approximately 1 msec.

59
 Vignetting

A fall-off in brightness at the periphery of

an image is called vignetting. Vignetting
is caused by the unequal collection of light
at the center of the image intensifier
compared with the light at its periphery.
As a result, the center of an image
intensifier has better resolution,
increased brightness, and less distortion.

60
 Veiling Glare
Scattering of light and the defocusing of
photoelectrons within the image
intensifier are called veiling glare. Veiling
glare degrades object contrast at the
output phosphor of the image intensifier.
As mentioned, the contrast ratio is a good
measure of determining the veiling glare of
an image intensifier. X-ray, electron, and
light scatter all contribute to veiling glare.
61
 Pincushion Distortion
•Pincushion distortion is a geometric, nonlinear
magnification across the image.
•The magnification difference at the periphery of the
image results from the projection of the x-ray beam
onto a curved input surface.
•The distortion is easily visualized by imaging a
rectangular grid with the fluoroscope.

62
 S Distortion
Electrons within the image
intensifier move in paths along
designated lines of flux. External
electromagnetic sources affect
electron paths at the perimeter of
the image intensifier more so than
those nearer the center. This
characteristic causes the image in a
fluoroscopic system to distort with
an S shape .
Manufacturers include a highly
conductive mu-metal shield that lines
the canister in which the vacuum
bottle is positioned to reduce the
effect of S distortion.
63
 RECORDING OF FLUOROSCOPIC
IMAGE
 There are two modes of recording fluoroscopic image
 Light image recorder (by photospot camera or Cine
camera)
 TV image recorders

64
 Light image recorder

 Spot film recorder/

camera
 These devices interpose
an x-ray film cassette
between the x-ray beam
and the image intensifier
tube
 Fluoroscopy is conducted
at about 80-90 kvp and 1-
3 mA of tube current but
 Exposure of the spot film
uses fluoroscopic kvp but
require higher mA (300-
400 range) 65
 There is photometer which controls the
length of exposure
 Roll film of 70 mm and 105 mm
 Sheet film 100 mm used

66
Advantages
Advantagesof ofspot
spotfilm
filmcamera
cameraover
overany
any
direct
directfilming
filmingmethod
method

•Exposure
•Exposuretime
timeshorten
shorten
•Rapid
•Rapidfilming
filming(max.
(max.framing
framing12
12fps)
fps)
•Reduction
•Reductioninindose
doseisis30%
30%ororless
lessthan
thanroutine
routine
filming
filming
•Better
•Betterclinical
clinicalsetting
setting
•Reduced
•Reducedfilm
filmstorage
storageproblem
problem

67
 CINEFLUOROGRAPHY

 The film is exposed at

rates usually in excess of
16 fps.
Cine film
 16 mm and 35 mm
 Length 85 or 150 mm
X-ray generator
 High output 130-200 kw

68
Framing rate

 16 mm camera permits – upto 200 fps

 35 mm camera permits – upto 150 fps

Exposure time
 5-6 ms (0.005-0.006s)

TV IMAGE RECORDERS
 The second method of recording the fluoroscopic image
involves recording the electrical signal from the TV camera
and this can be done by magnetic tape, magnetic disc and
optical disc recorders
 Dry silver image is latest technology by which it is
advantageous that no wet chemical processing is required
69
 ADVANCEMENTS IN
FLUOROSCOPY
Digital fluoroscopy system

 Definition: Preparation of fluoroscopy image with

the aid of digital image processing system is called
digital fluoroscopy
 The design of digital fluoroscopy system can be
considered to be a fairly conventional fluoroscopic
unit with an added digital image processing unit.

70
 EQUIPMENT:

 -D.F. requires the same fluoroscopy

equipment in addition to a computer, 2
video monitors, and a more complex
operating console.
 -A high voltage generator.
 -A video system.
 -A charge couple device.

71
71
 72
72
 ADVANTAGES:
 D.Fpermits high speed digital image
acquisition,processing & display
 -Better image quality.

73
73
Video
Videosystem
system

 In conventional fluoroscopy – 525 lines system

are used.
 In digital to obtain higher spatial resolution images
video system with 1000 lines can be used.
Digital fluoroscopy TV camera tube is replaced by
charge couple device because it gives better
spatial resolution image

74
CHARGE COUPLE DEVICE
 It is photosensitive silicon chips, when
illuminated, an electric charge is generated
which is sampled pixel by pixel to produce
a digital image
 CCD is mounted on the output phosphor of
the image intensifier tube and is coupled
by lens system or directly coupled
 Vidicon stores +ve charge but it stores –ve
charge
Readout process
 Vidicon camera is read out an electronic
beam
 The CCD is read out by the charge in the
charge buckets being moved from one to
the next until charge reaches the edge of
the CCD where it forms electric signal 75
 CCD
CCD

These
Theseare
arepixilated
pixilatedlight
lightdetectors
detectorsmade
madeofofcyst
cystline
linesilicon
silicon
Which
Whichare
aresimilar
similartotoCPU
CPU(center
(centerprocessing
processingunit)
unit)ofof
computer
computerininwhich
whichelectronic
electroniccharge
chargebuilds
buildsupupinineach
each
detector
detectorelement
elementas asaaresponse
responsetotoLight
Lightexposure.
exposure.
Once
OnceCCDCCDchip
chipisisexposed
exposedelectronic
electroniccharge
chargethat
thatreside
resideinin
chip
chipisisread
readby
byaaprocess
processcalled
calledbucket
bucketbrigade
brigade. .

76
 ADC DAC

I.I
I.I
COMPUTER MEMORY MONITOR

CONSOLE

77
 Flat Panel Detector System
o Amorphous silicon solid state detector
 In this type of detector the pixel design is based on double diode
concept with which the switching elements and the photodiode are
simultaneously realized in order to reduce the no. of processing
steps. Hence the image can be viewed immediately.

o Advantage
 Reduce the radiation exposure
 Due to large surface area acceptable signal to noise ratio and high
frame rates.

o Disadvantage
 New units based on this new technology are required
 For each type of work different units are required
 Cost

78
 RADIATION DOSE LEVEL
DURING FLUOROSCOPY
 Continuous fluoroscopy 50 mGy/min
 Pulsed fluoroscopy 10 mGy/min
 Cine fluoroscopy 0.4 Gy-1Gy/min
(at 15 fps-60 fps)
Radiation injury after fluoroscopic procedures
 Skin ulceration >25 Gy
 Temp. loss of hair (epilation) 3-5 Gy
 Lens opacities 2-4 Gy
 Cataract formation 7.5 Gy 79
DOSE RECOMMENDED PER FAME (OR
FILM) EXPOSURE FOR VARIOUS
IMAGING SYSTEM)

Imaging Film size Exposure/

modes frame
Cinefluorogra 16-35 mm 20 µR
phy
Spotfilm 70-105 mm 100 µR
camera
Serial 35x33 cm 300 µR
radiography
80
 RADIATION PROTECTION
 Aside from the ALARA principle and compliance
with state and departmental monitoring and
exposure reduction policies or regulations
fluoroscopic personnel can use several protective
devices and techniques to minimize occupational
exposure
 The following points should be observed to
minimize radiation during fluoroscopy
81
 From radiation protection point of view the
x-ray tube target should be at least 18”
below the table top. And table top
exposure should not exceed 10 Roentgens
per minutes. Tables with bucky grid
mechanism have a hinged lead strip that
fills the opening in the side of the table
where cassettes are slid into a tray during
radiography.

82
 Commulative fluoroscopic timer
 It is also an essential requirement in
fluoroscopic units. It is also called a 5
minutes safety timer as it measures the
accumulated fluoro time during exam. and
turns off the unit or gives sound after 5
minutes. And need to be reset after every
5 minutes of exposure.

83
 All personnel involved in
fluoroscopic procedure should
wear appropriate garments eg.
• Thyroid shield (0.5 mm thickness)
• Lead gloves
• Leaded eye glass
• Lead apron (0.5 mm thickness)
 Always wear a film badge or TLD
 Preferably use IITV system if
available
 Keep the tube current as small as
possible
 Do not collimate the image field
larger than required (use
automatic collimation if available)
 Carry out fluro for short time as
possible

84
• Use the foot switch for fluro, hand should be
used only when the spot film are to be taken
• Do not reach into the radiation with unprotected
hand (wear lead e.g. gloves)
• A 5 min safety timer is required by law on all
fluoroscopic system. It reminds the operator
how much time has lapsed.
• Keep distance from patient to prevent scatter
radiation
• Use gonadal shielding (Pb rubber cover) .

85
 Note
Note ::
• the department should implement a quality

assurance program that includes regular

equipment maintenance and inspection and

establish procedure protocols that are reviewed

and update periodically

86
87