ory aaa Digital Fluoroscopy Cel Jixeu tN =c) PS en Cen nO Rese eon Cos cores Seer aeons Seon eee Sesto ER a Ramee one 3. Compare the use of a TV camera tube with a CCD 4. Outline the procedures for temporal subtraction and energy Peaacenenl PR eet Re Prete ce neuer Secu OUTLINE igital Fluoroscopy High-Voltage Generator Charge-Coupled Device Video System fetid ere Leroi Tete er ue a re ST Display System Rear See aon)shadowgraph-type image ona receptor that is directly produced from the transmitted x-ray beam. Image intensifier tubes serve as the fluoro- scopicimage receptor. These tubes are usually elec- ironically coupled to a television monitor for re- mote viewing, as described in Chapter 24. Figure 28-1 diagrams the components used tional fluorescopy. Digital fluoroscopy (DF) identifies a digital x-ray imaging system that produces a series of dynamic images obtained with an area x-ray beam and an image intensifier. The difference between conven- tional fluoroscopy and DF is the nature of the image and the manner in which it is digitized. ———— SS C ONVENTIONAL FLUOROSCOPY produces a conven- ‘The medical physies groups at the University of Wisconsin, and the University of Arizona independently initiated studies of DF in the early 1970s. These studies were con- tinued through the decade by the research and develop- ment groups of most x-ray equipment manufacturers. The approach was to use fluoroscopic equipment while placing a computer between the television camera and the television monitor. The video signal from the television camera was routed through the computer, manipulated in various ways, and transmitted to the television monitor in a form ready for viewing. ‘The initial investigators of DF demonstrated that nearly instantaneous, high-contrast subtraction images could be obtained after intravenous injection of contrast media. Although the intravenous route is still widely used, intraarterial injections are also used with DE. ‘The advantages of DF over conventional fluo- roscopy are the speed of image acquisition and postprocessing to enhance image contrast A 1024 X 1024 image matrix is sometimes described as, 2 1000 line system. In DE, the spatial resolution is de- termined both by the image matrix and by the size of the image intensifier. Spatial resolution is limited by pixel size. DE PIXEL SIZE Image intersifier size Pixel Size = ‘Matrix intensifier FIGURE 28-1. The imaging chain in conventional fluorosny Question: What is the pixel size of a 1000-line DE system operating in the S-inch mode? Five inches equals 127 mm (5 X 25.4 mav/inch}. Therefore, the size of each pixels 127 mm “Toa = 0-124 mm Answer: DIGITAL FLUOROSCOPY A DF examination is conducted in much the same nas ner as a conventional fluoroscopic study. To the casa observer, the equipment is the same, but such is noth case (Figure 28-2}. A computer has been added, aswel as two monitors and a more complex operating cons: Figure 28-3 showsa representative operating const of a dedicated DF imaging system. It contains alphin meric and special function keys in the left module fi entering patient data and communicating with the c= puter. The right portion of the console contains adé tional special function keys for data acquisition andi age display. ‘The module on the right also contains compute interactive video controls and a pad for cursor and re gion of interest (ROI) manipulation. Other systems ws a trackball, joystick, or mouse instead of the pad. Twi monitors are used. The left monitor is used to edit tient and examination data and to annotate final it ages. The right monitor displays subtracted images. High-Voltage Generator During DR, the undertable x-ray tube actually opeats in the radiographic mode. The tube current is measirl in hundreds of mA instead of less than 5 mA, as ini age-intensifying fluoroscopy. This is not a problem, however. If the tube were et ergized continuously, it would fail because of therm overloading, and the patien: dose would he exceedig)CHAPTER 28 409 FIGURE 28-2 The components of a digital fluoroscopy system. FIGURE 28-3 Operating console for a digital fluoroscopy system. (Courtesy Toshiba Medical Systems.) tigh. Images from DF are obtained by pulsing the x- ay beam in a manner called pulse-progressive fluo- ‘scopy. A During DF, the x-ray tube operates in the radio. hic mod tage acquisition rates of 1 per second to 10 per second se common in many examinations. Because it requires 33 ms to produce one video frame, x-ray exposures longer than that can result in unnecessary patient dose. That is a theoretical limit, however, and longer expo- sures may be necessary to ensure low noise and good image quality. Consequently, the x-ray generator must be capable of switching on and off very rapidly, The time re- quired for the x-ray tube to be switched on and reach the selected levels of kVp and mA is called the inter- rogation time. The time required for the x-ray tube to bbe switched off is the extinction time. DF systems