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13 - Fluoros
13 - Fluoros
Real-time imaging
Most general-purpose fluoroscopy systems use TV technology, operating at 30 frames/sec May be recorded (barium swallow examinations) or unrecorded (catheter positioning) Cinecardiography may operate at 120 fps using 35mm film Higher sensitivity than screen-film systems
1 to 5 R per frame versus 600 R for a 400-speed screen-film system to give OD = 1.0
Image intensifier
Four principal components:
A vacuum bottle to keep air out An input layer to convert the x-ray signal to electrons Electronic lenses that focus the electrons An output phosphor that converts the accelerated electrons to visible light
Input screen
Input screen consists of four layers:
The vacuum window (thin Al window that is part of the vacuum bottle) A support layer (also thin Al), curved for accurate electron focusing The input phosphor (CsI in thin, needle-like crystals) The photocathode (a thin layer of antimony and alkali metals, such as Sb2S3) that emits electrons when struck by visible light
Output phosphor
Made from zinc cadmium sulfide doped with silver (ZnCdS:Ag), which emits green light Small phosphor particles (1 to 2 m) in a thin coating (4 to 8 m) to preserve high spatial resolution Anode is a very thin (~ 0.2 m) coating of aluminum on the vacuum side of the phosphor
Modes of operation
Continuous fluoroscopy
Basic form of fluoroscopy; continuously on x-ray beam
Frame averaging
Frame averaging
Fluoroscopy images generally noisy Sometimes beneficial to compromise temporal resolution for lower noise images Digitize fluoroscopic images and perform real-time averaging in computer memory for display
I displayed I n 1 I n 1
Video signal itself can be used to sense light output ABC can adjust both tube current and generator voltage
Image quality
Spatial resolution of the II best described by modulation transfer function (MTF) The limiting resolution of an imaging system is where the MTF approaches zero Higher magnification modes (smaller fields of view) are capable of better resolution Video imaging system degrades the MTF substantially
Fluoroscopy suites
Smaller facilities may use one fluoroscopic system for a wide variety of procedures Larger facilities have several suites dedicated to specific applications, such as:
Gastrointestinal suites Remote fluoroscopy rooms Peripheral angiography suites Cardiology catheterization suites Biplane angiography systems Mobile fluoroscopy C arms
Radiation dose
Maximum entrance exposure rate for fluoroscopy to the patient is 10 R/min (see http://www.hcsc.gc.ca/hecs-sesc/ccrpb/publication/safety_code20a/toc.htm) Low-dose techniques include heavy x-ray beam filtration, use of low frame rate pulsed fluoroscopy, and use of lower-dose ABC options Last-frame-hold features often reduce fluoroscopy time Using the largest field of view suitable to a given clinical study also helps reduce radiation dose to the patient
Dose to personnel
Occupational exposure of physicians, nurses, technologists, and other personnel who routinely work in fluoroscopic suites can be high Lead aprons should be worn when the x-ray beam is on Portable lead glass shields should be available for additional protection to staff members observing or otherwise participating in the procedure Reducing total fluoroscopy time is beneficial to everyone