Notebook: Fluoroscopy Historical Timeline Name:~« 7" Z Date Occurrence 1895 Roentgen discovered x-rays- he placed his hand between the tube and screen and saw his fingers 3/3/1896 & 4/18/1896 1 reports of possible bodily damage by x- i rays & 1° skin effects noticed, July of 1896 1* protective x-ray device created: heavy glass plate to protect the eyes. 1896 More contributors to this technology- Salvioni of Italy, MeGie of Princeton, and Thomas Edison (used Clarence Daly's hand) July of 1896 Al filter used as protection device. May of 1898 Dark adaption prior to fluoroscopy suggestion (allows eyes to adapt to dark light). October of 1904 Clarence Dally is the 1* death of an x-ray pioneer from cumulative exposure. 1907 Photographic plate carried in pockets for monitoring exposure by Wagner. 1915 British Roentgen Society adopts protection recommendations 1922 Film badges for personal monitoring, developed. 1937 Irving Langmuir patented the image intensifier 1948 4.W Caltman improved upon the design so the image brightness increased 1000 times 1953, Westinghouse Company manufactured the first commercial image intensifier 1940s Fluoroscopy used to x-ray permits 1950s Fluoroscopy used for shoe fitting- the salesman would look from above while customer put foot on «ray source 1950s cont'd The doctor looked directly through the screen in a darkened room but was radiation dose was extremely high | http://www.physics.isu.edu/radinf/timeline. htmNotebook: Fluoroscopy Historical Timeline Name: ~ Ina narrative, list and describe the terminology of basic visual physiology and determine its importance in radiology image illumination. ° Photopic vision: “daylight vision”. This is the current way that fluoroscopy is visualized. Scotopic vision: “nighttime vision”. A dark room or special goggles help enhance this type of vision; this was where ‘dark adapt’ came from (fluoroscopists would sit in a dark room for 15 mins to allow their eyes to adapt which allowed for the rods in the periphery of the retina to activate. Ullumination that the eye can see is measured in lumens or cd/m2 (lux). ‘Anatomy and function of the eye: * Cornea: light passes through the transparent protective coating of the eye. © Lens: shaped disc that focuses the incoming light into the retina, ‘Iris: this anatomy is b/t the cornea and the lens and acts like a diaphragm as it adjusts to control the amount of light coming into the retina. ‘© Bright light: iris contracts to limit the incoming light. ‘© Low light: iris dilated to allow more light to enter. Rods (100 million) and cones (6 million) are embedded in the retina * Rods are only in the periphery of the retina and are sensitive to low light. They cannot respond to intense light (2 lux). This is where nighttime and dim vision occurs- scotopic. © Periphery allows opjects to actually be visualized, © Cones are in a ‘pocket’ called the fovea centralis. They are less sensitive to light and can respond to intense light (100 lux). Cones are for daylight vision and are Aphotopic, This is also where color is formed.oN btPart B: List all the components slide of mobile and fixed fluoroscopy, add a brief description of its function or purpose. Mobile 1._ Display monitor: high-resolution monitor to display the images. TV camera: uses a CCD to capture the image prior to it being sent to the display monitor. 3. Image intensifier (detector): converts x-rays into visible light image. Primary beam exits the patient and hits the input window of the Il (which is made of a fluorescent screen). X-ray photons are then absorbed and light photons are emitted and captured by the photocathode, Table top to detector Table top: radiolucent carbon fiber material and has weight limit between 300-600Ibs. Source to table top Linear collimation: collimates linearly; used to reduce scatter and improve visualiza of detail through improved contrast resolution. Iris collimator: collimates circularly. X-ray tube (source): high voltage generator and x-ray tube where electrical energy is converted into the beam. Radiation output can be either continuous or pulsed. AEC’s maintain the radiation dose per frame. 10. Patient ee Fixed 1. TV/LCD: high-resolution monitor to display the images. Video camera: uses a CCD to capture the image prior to it being sent to the display monitor. 3. Image intensifier: converts x-rays into visible light image. Primary beam exits the patient and hits the input window of the Il (which is made of a fluorescent screen). X-ray photons are then absorbed and light photons are emitted and captured by the photocathode. Anti-scatter grid: reduces scatter. Patient Filter: reduces the entrance skin dose (ESD). Xray tube: source of the radiation beam novePart C: Describe the flow of electrons in a narrative or with bulleted statements beginning at the source through the image intensifier. Page 537 1 One photon (at least 50keV) enters input fluorescent screen at the bottom of the glass envelope. Fluorescent screen then converts the one photon into 2,000 light photons. The light photons go through the photocathode and are then converted to electrons that are negatively charged. The negatively charged photoelectrons are then repelled by the negatively charged electrostatic lens that lies within the glass envelope. This repulsion directs the electrons towards the positively charged anode. Those electrons are shot through the output fluorescent screen to produce more light Photons that ends up creating the image (the one original photon has now been Converted into 200,000 light photons which leads to the resulting image)1, While using a 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? 10: contrast increased, largest field of view, focus is closest to the phosphor 5: contrast decreased, best spatial resolution 2. Describe minification gain and the relationship with increasing input phosphor size, kVp, mA, output phosphor size, and tube voltage. Minification gain: pg. 539 photocathode is large {image is smaller- output phosphor is smaller) The bigger the input phosphors the more minificaiton and brighter the image is with more light photons at the output screen. kVp: if kVp is upped by 15% thus doubling the amount of energy coming through, everything is increased. More pt dose and no relationship to minificaiton gain, mA: as kV/p is increased, the mA lowers and visa versa. No relationship to minificaiton gain. Output phosphor (measurement of luminous intensity) size: the smaller the output phosphor the more minificaiton there is and visa versa (minificaiton gain= ratio the areas of the input photocathode to the output florescent screen: geometric size difference). Tube voltage: no relationship, more power in the tube the brighter the image but no one cares. This affects flux gain. 3. 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 the input phosphor and the output phosphor. Magnification mode is the ability of multiple diameters to be made available within one image intensifier. The size is chosen by increasing the voltage to the electrostatic focusing lenses. When the voltage is increased, the electron stream is “tightened” or made smaller, and these are the only electrons that interact with the output phosphor screen. This tightening changes the focal spot, moving it away from the output screen Mag mode increases technique due to the closer proximity of the focal spot; spatial resolution will be increased due to the closer focal spot. Contrast is decreased when magnification is increased because focal spot is moved closer to the source of the image (photocathode)- image is spread over 2x the area and therefore contrast and density are lost.Equations used in fluoroscopy Flux gain = number of output light photons Number of input x-ray photons Brightness gain = Minification gain x Flux gain or use the conversion factor equation. Minification on gain = (direst)? (output)? Conversion factor = output phosphor illumination (cd/m?| Input exposure rate (mGy./sec.) Magnification factor = mode 2 in multifield Image intensifier Mode 1 ‘New ESD = Original input screen size X Entrance Skin Dose ‘New input screen size 4. What is the brightness gain for a 17- em image intensifier tube with a fl and a 2.5 cm output phosphor? x in gain x flux gain: 17x2.5 = 42.5 gain of 120 5. A 23/15/10 (ratio diameter) image intensifier is uSéd in the 10cm mode. How much higher is the patient dose using this mode compared to using the 23 cm mode? Principal: when using the magnification mode, the minification gain is reduced, so fewer photoelectrons are hitting the output phosphor. This creates a dimmer image. To compensate for the magnification mode (maintain the same amount of brightness), the tube mA is increased. The increase in dose to the patient when changing from 23 cm to 10 cm is equal to the ratio of the input phosphor diameter to the diameter used in magnification mode. 23°2/1092= 5.29 6. What is the change is dose (how much higher) when switching from a 23cm FOV to a 17cm FOV? Use same principal as in question 5 2392/1792= 1.82 A7. A photofluoroscopic image is obtaining using the technical factors of 80 kVp in the 15cm mode without a grid. He measured entrance skin dose (ESD) is 0.5. mGyt What ESD would be expected if the 25cm mode were used? Original input screen size X ESD = New ESD New input screen size iy 1542/2542= .36x.5=0.18 DOSE 15 SQUARED (=AREA) 8. A23cm image intensifier has an output phosphor size of 2.5cm and a flux gain of 75. What is the brightness gain? o& 2342/2.592= 33-6.25 x (75) =247968.75 \ Na 129 Wart 1S = L34t O 9. Create a scenario using one of the equations above with the specific factors required. Be sure to show your work and include the answer. What is the brightness gain for a 22cm image intensifier tube with a flux gain oft 115 nd a 3.0 cm output phosphor? Magnification gain: (22)42/(3)42= 53.53 Brightness gain: 53.53x115= 6155.95 ed/mR — c/) .1. Describe how the image changes as FOV-changed phantom to a thin portion. Include noise, technical factors 3. Noise Assown et tatlang dse changed, Here is Nose when going, toe SO part b. Technical Factors Also: ~ \y--due—-to- ~decressed Size cc. Contrast resolution : peau a sista Trinner port > lower Oi, So lotwer ldagneBicatiah his Lor Contrast, bot also thine adefouy w/redua's foarcrast due PEsbieck. Conkast d. Brightness Wen “FOV is Smaller Lrigitress Stays the Same oS teh. factors ole abiotted to Verp Unifottuniby wf tmagsd toll mation [ehoage ie ov 2. Explain how ABS worked in relation to magnification, and dosimetry reading in regular and pulsed mode. pee FOV1 Regular Pulsed © SYune pet Sec Cam’ taceh. peti & ) SOV IS Compressed, Mee exposoa ae 4 (unless hegpr wl isoed) 2OY FS Cont A dain 5 Less exposore Fov2 Abd: kth + liven WA ot :Name. 3. What changes occurred in the image when collimators were open versus closed, in relationship to brightness (density), noise/fog, and contrast resolution. AS cllination fone Aedhnigue ts modad Boosh + iN Aitsolvion in image,Name. Po 3. Describe the processed CR images and the exposure index, or film density using a densitometer, Write your conclusion about the findings, Location 1: Location 2: Location 3: Location 4:Name. Lab analysis: 1. Describe how the image changes as the unit is moved from a thick part of the phantom toa thin portion. = a, Abdomen Co Hip Zom-tedaniad , Thedwigve - Sor KN COtCN.. Choam. is Narrowed afin (oi Coca OPA IS Chenging, Mom. cokput bow to wk pbosftor) it Extremity f\b5 i (oud dite Un vdose 2. Explain how ABS worked and what happened to the technical factors. Describe what ‘was seen at varying kVp and mA settings. AB Woh ko change Lngtters ab atatuie location henge las) cecors Eo Ughap hee 65 fark Hielouns charg rity ABS. AB toh £ brights ineneesed yf thea in tees Ractrs wD Briqtas + nd el. RatersCreate a chart using the Table below to compare Digital Fluoroscopy Equipment and Image Intensified Fluoroscopic Equipment. Include information related to patient dose, contrast resolution, spatial resolution, size of the component, distortion, tube mA’s. Digital Fluoroscopy Equipment Components Image Intensified Equipment Components CCD: replacement for the “camera tube”; light collector Video camera Flat panel detector: either direct capture configured with amorphous selenium or indirect capture that uses cesium iodide (used as scintillator) amorphous silicon (is the photodetector) Light out TFT array: operates the same way as in static imaging ‘Output phosphor Faster image acquisition speed Focusing electrodes ‘Smaller size, distortion not seen Input phosphor Better contrast Magnification requires higher technical factors and x-ray exposure ‘50% lower patient dose ‘Small dynamic range Post processing xray detector is not sensitive [Large dynamic range &