Lindsey Shriner

Notebook 10
Fluoroscopy
Historical Timeline-

Date: Occurence:

November 8th, 1895 X-rays were discovered by Wilhelm Roentgen

1896 Injury to eyes and skin effects first noted from X-

rays. Protective apparel introduced

1898 Aluminum filter and leaded X-ray tube housing

introduced

1904 The first death in X-ray- Dahly

1907 Mutation in toads seen from X-rays

1920 First standing X-ray protection committee started

1922 First film badges for personnel monitoring

1927 Genetic effects of X-rays shown

1937 Irving Langmuir patented the image intensifier

1948 J.W. Coleman improved design so image

brightness increased by 1000%

1953 The first commercial use image intensifier

manufactured by Westinghouse company

Basic Visual Physiology-

The eye has two types of vision, photopic and scotopic. Photopic is daylight vision and
it is the current way that fluoroscopy is seen. Scotopic vision is nighttime vision and darkened
rooms and special goggles help this vision. Cones and rods are photoreceptors, the cones are
located within the Fovea centralis and the rods are found in the periphery of the retina layer. The
incoming light passes through the cornea where it is focused by the lens and the iris acts as a
diaphragm and adjusts to the amount of light coming into the retina where the cones and rods
are embedded. There are 100,00 rods and cones per mm^2 area, the rods are only in the
periphery and are sensitive to low light, the cones are in a pocket called the fovea centralis and
are less sensitive to light and can respond up to about 100 lux. Diagnostic x-rays are displayed
at 100-1000 lux. Cones are daylight vision and this is where color is formed, they see detail and
contrast perception. Rods are nighttime vision and dim objects are viewed peripherally. The goal
for better image diagnosis is to use the cones so image brightness needed to increase.
 Lindsey Shriner

Mobile Fluoroscopy-
1. Display monitor- where images are displayed
2. TV camera- captures the image
3. Image intensifier (detector)- makes the image brighter
4. Tabletop to detector- space from table to II
5. Tabletop- radiolucent where patient lays
6. Source to tabletop- x-ray tube to the table
7. Linear collimator- filters the beam
8. Iris collimator- filters the beam
9. X-ray tube (source)- where the photons are produced
10. C-arm motion- how the c-arm moves
11. Patient- person being examined
Fixed Fluoroscopy
1. TV/LCD- where the image is displayed
2. Video camera- captures the image
3. Image intensifier- brightens the image
4. Anti-scatter grid- captures scattered photons
5. Patient- person being examined
6. Filter- filters out soft photons
7. X-ray tube- where photons are produced
Electron Flow-
One photon enters input fluorescent screen and converts to low light photons. The light
photons go through photocathode to convert to photoelectrons that are negatively charged. The
negatively charges photoelectrons are repelled by the negatively charged electrostatic lens to
direct the electricity towards the positively charged anode. Those electrons go through the
output fluorescent screen to produce a lot more light photons to create an image.

 Lindsey Shriner

Digital Fluoroscopy Equipment Components Image Intensified Equipment Components

Flat panel or CCD Conventional

Faster speed to acquire images Computer placed between the Image Intensifier
and the viewing monitor- ADC

Post-processing of images to enhance edges, Camera tube that split signal between recording
called image subtraction system and viewing monitor

Multiple monitors Curved input phosphor leading to peripheral field

of view distortion

Can remotely control the imaging system X-ray detector not sensitive

Flat detector with maintained spatial resolution in Small dynamic range of x-rays exposure
periphery

Highly sensitive x-ray detector Magnification requires higher x-ray exposure

Large dynamic range of x-ray detected System developed using analog technology

Magnification requires less x-ray exposure

Digital technology

Advantages of Digital- Smaller size, less bulk and weight of carriage, does not degrade with
age, better contrast resolution, higher DQE, wider dynamic range, distortion is not seen, 50%
lower radiation dose to the patient, can use post processing functions, not sensitive to
magnetic fields, or electronic noise.
While using an image intensifier with a 10/7/5 diameters, which size is best for contrast
resolution and why? Which one is best for spatial resolution and why? Which one has the
largest field of view?
7 is the best contrast resolution because of the techniques used. 5 is the best for spatial
resolution because its the smallest so it will have more details. 10 will have the largest field
of view because of the diameter.
Describe magnification gain and the relationship with increasing input phosphor size, kVp,
mA, output phosphor size, and tube voltage.
Taking the same number of electrons that are emitted at the photocathode and using them
to create the image at the smaller output screen and there is no relationship to mA or kVp.
Describe what occurs when the image intensifier is operated in the magnification mode as it
relates to contrast resolution, spatial resolution, patient dose, the relationship of the focal
point between they put phosphor and the output phosphor.
 Lindsey Shriner

The contrast resolution will decrease, the spatial resolution will increase, the patient dose
will increase the closer the focal point is to the input phosphor, and a large input means a
small output.
What is the brightness gain for a 17 cm image intensifier tube with a flux gain of 120 and a
2.5 cm output phosphor?
Minification on gain- 17^2/2.5^2 = 289/625 = 46.24
Brightness- 46.24 x 120 = 5,548.8
How magnified is the image of a 25/17/12 image intensifier in the 17 cm mode compared with
that produced in the 25 cm mode?
Magnification factor- 25/17 = 1.5 cm
A 23/15/10 image intensifier is used in the 10 cm mode. How much higher is the patient dose
using this mode compared to using the 23 cm mode?
Dose- 10^2/23^2 = 100/529 = 0.189 dose
What is the change in dose when switching from a 23 cm FOV to a 17 cm FOV?
23^2/17^2 = 529/289 = 1.83 dose
A photofluoroscopic image is obtained using the technical factors of 80 kVp in the 15 cm
mode without a grid. The measured entrance skin dose is 0.5 mGy. What ESD would be
expected if the 25 cm mode were used?
15^2/25^2 = 225/625 = 0.36 dose
A 23 cm image intensifier has an output phosphor size of 2.5 cm and a flux gain of 75. What
is the brightness gain?
23^2/2.5^2 = 84.64 x 75 = 6348
What is the change in dose when switching from a 12 cm FOV to a 17 cm FOV?
12^2/17^2 = 0.498 dose
LAB-
In the abdomen as the part thickness is increased the darker the image will be and the
thinner the part the brighter it will be. The chest would be the same except the lungs would be
brighter and the spine and heart would be darker. The same would happen with the hip and the
extremities, the thicker the part the darker the image.
ABS-
Maintains the same brightness throughout the anatomy no matter the part thickness or
density. More mA is greater brightness and should be increase for thicker parts. More kVp with
thicker parts also but this means less spatial resolution.
 Lindsey Shriner

Collimators-
With increased collimation we get more detail and spatial resolution, less noise/fog,
brightness would decrease also as would contrast resolution, the opposite would be true for
decreased collimation.

Describe how the image changes as FOV changed phantom to a thin portion. Include noise,
technical factors.
Noise-
The larger the FOV means more noise for both thick and thin parts.
Technical factors
Thick parts with larger FOV means increase in kVp and mA.
Thin part with large FOV means a decrease in techniques
Thick part with small FOV means an increase in techniques and a higher than large
FOV.
Thin part with small FOV means and increase in techniques and a higher than large
FOV.
Contrast resolution-
Small FOV with thick part means more contrast resolution
Large FOV with thick part means less contrast resolution.
Small FOV with thin part means more contrast.
Large FOV with thin part means less contrast
Brightness-
Small FOV with a thick part means a darker or less bright image.
Small FOV with a thin part means a less bright image.
Large FOV with a thick part means a brighter image.
Small FOV with a thin part means a brighter image.

Explain how ABS worked in relation to magnification, and dosimetry reading in regular and
pulsed mode.
Regular- Our techniques stayed the same as did our dosimetry reading when we used
regular
Pulsed- The techniques fluctuated between high and low and also depending on anatomy
thickness.
 Lindsey Shriner

Describe the processed CR images and the exposure index or dilm density using a
densitometer. Write your conclusion about the findings.
The film 3 feet away had a rail that was clearly visible from the bed where it was placed.
This means that it was almost directly being exposed from the primary beam.
The film that was 6 feet away had some exposure on it but it was not as clearly defined at
the closer film but photons did reach it and expose it.