Fluoroscopy

Roshan Chaudhary
 Introduction

 Imaging technique commonly used by physicians to obtain real time images

of the internal structures of the patient through the use of fluoroscope.
 8th November, 1895- W.C. Roentgen noticed Ba-platinocyanide screen
fluorescing as a result of beam exposed to what he would later call as X-rays.
 In 1896, Thomas Edison designed the first commercially available
fluoroscope.
Primary Function:
 Real time imaging
 Visualization of dynamic process of organ motion/ingested (Orally) )or
injected contrast agents.
 Positioning catheters/biopsies/needles (e.g. angio) – tracking contrast media
(HSG, ERCP, sinogram)
Early Fluoroscopoic Systems

CONVENTIONAL FLUOROSCOPY: INVENTED BY THOMAS

EDISON (1896)
Early Fluoroscopoic Systems

Photograph shows an early (1933)

fluoroscopic system in use before the
development of image intensification.
An actual fluoroscopic examination with this
device would have occurred
in a darkened room.
Early Fluoroscopic Systems

Consists of:
-X-ray tube &
-Fluorescent screen (Cu: ZnCdS)
 Early Fluoroscopic Systems

Early fluoroscopy = Image was viewed directly – X-ray photons strike the
fluoroscopic screen – emits visible light.
 Early Fluoroscopic Systems
 Fluoroscopic Image viewing based on Human Vision.
Cones: Photopic (daylight) Vision.
Rods: Scotopic (night) Vision;
Most sensitive to blue-green light – Daylight levels reduce the
sensitivity to low illumination levels; \
Required red goggles for dark adaptation (to filter out blue green
wavelengths)
The dim fluoroscopic vision required use of rod vision, with its poor
visual acuity and poor ability to detect shades of gray (contrast).
DISADVANTAGES:
 Requires complete darkroom.
 High Radiation dose to the patient and the operator.
 Only single person can view the image.
 Requirements

What was needed????

–Image bright enough to allow cone vision
–Without excess radiation exposure.
– Possible with Image Intensifier (II) Tube Systems.

 II Tube Systems produce an image bright enough to allow cone

vision without giving the patient an excess radiation exposure.
Fluoroscopic Imaging Chain

Fluoroscopic X-ray tube

 Similar to diagnostic tubes except:
 Grid Controlled.
 Designed to operate for longer
periods of time at much lower mA
i.e. fluoroscopic range 0.5--5 mA
(usually ave 1--2 mA)
 Operate by foot switch.
 Fluoroscopic X ray Tubes

2 Types:
 Over couch X ray Tube.
 Under Couch X ray Tube.
Offers less scatter radiation to the operator than Over-couch X
ray tube systems
Preferable to have X ray tube mounted below the Patient Couch.
Other C Arm Fluoroscopic/Interventional Suite.
Fluoroscopic X ray Tubes
 Fluoroscopic Couches/Table
 Mostly tilting Type
 Identified by their degrees of tilt.
 Allows patient to be lowered and raised.
 Image Intensifier Tube

 Developed in 1953.
 Evacuated vacuum tube.
 Converts x-ray into visible light image.
 Amplifies the image brightness approx. 5000 to 20000 times.
 II Tube Design

 The tube itself is an evacuated glass envelope ,a vacuum tube.

Components of II Tube:
Glass/Metal Envelope
Input phosphor
Photocathode
Electrostatic focussing lens
Accelerating anode
Output phosphor
 Components of II Tube

Glass/Metal Envelope  Provide mechanical, anti-

magnetic protection to the tube.
 Vacuumed glass or metal tube.
 2.4 mm in thickness, enclosed in
a lead lined metal container.
 Must be light-tight, dry &
dust/leakage proof.
 Function
 Components of II Tube

Input phosphor
 Initial input phosphor used in early image intensifiers was
zinc-cadmium sulfide (ZnCdS),
 Current phosphor of choice is cesium iodide (CsI:Na).
 CsI was deposited on a thin aluminum substrate by a process
called vapour deposition.
 CsI grew in tiny needles perpendicular to the substrate, .
 The phosphor thickness have been reduced from 0.3mm to
0.1, which produced increased resolution.
 Vacuum window (thin Al window); curved for accurate
electron focusing.
 Components of II Tube

Fig: Input Phosphor Fig: CsI:Na Crystals

Function: Input phosphor absorbs x-ray photons and converts their energy into light
photons.
 Components of II Tube

Input phosphor: Why CsI:Na??

 Image quality is dramatically better with
CsI input screen than it was with zinc
cadmium sulfide (ZnCdS) screens.
 Three physical characteristics of CsI
makes it superior to ZnCds.
1. Vertical orientation of the crystals.
2. A greater packing density &
3. A more favorable effective atomic
number.
 Components of II Tube

 For undistorted focusing, all photoelectrons must travel the same

distance.
 The input phosphor is curved to ensure that electrons emitted at the
peripheral regions of the photocathode travel the same distance as
those emitted from the central region.
 Components of II Tube

The photo cathode

 Made up of photoemissive metal (commonly a combination of antimony
& cesium compounds.
 Photocathode converts light photons into photoelectrons (photoemission).
 When the light from the input phosphor strikes the photo cathode, photo
electrons are emitted in numbers proportional to the brightness of the
screen.
 The photo cathode is applied directly to the CsI input phosphor.
 The photoelectrons thus produced has to be moved to the other end of the
image intensifier.
 This can be done using an electrostatic focusing lens and an accelerating
anode.
 Components of II Tube
Electorostatic Focussing  Electron focusing inverts and
Lens reverse the image ,this is called
as point inversion, because all
 Positively charged electrodes electrons pass through a
that are placed inside the glass
common focal point.
envelope.
 Preventing the diverging of the
x-ray beams as they travel from
cathode to anode.
 Components of II Tube

Accelerating Anode
 A circular plate with a hole in the middle to allow the e-s through
to the output phosphor.
 Located in the neck of the II tube
 The potential applied at the anode is +25 to +35 KV relative to the
photocathode..
 This results in gain of kinetic energy by the electrons .
 Components of II Tube
Output Phosphor
 Made of ZnCdS: Ag activated
 Converts photoelectrons to
visible light
 Smaller than the input
phosphors (to 1 inch)
 Crystal size and layer thickness
are reduced to maintain
resolution in minified image.
 Photo electrons have much
higher energies from input
screen
 More light photons (increase
approx. 50 folds).
Function---Produces a
fluoroscent image when electrons
strikes it which corresponds in
detail to the original but is much
brighter.
Components of II Tube
 Components of II Tube
Output Phosphor  Stops these photons from being
 Backed by thin aluminum film scattered back into the image
coating. intensifier and exposing the
 This aluminum film allows photocathode.
electrons to pass through, but it
is opaque to light photons
generated on the fluorescent
screen.
II Tube Performance/Characteristics

 Brightness gain
 Flux gain
 Minification gain
 Conversion factor
 II Tube Performance/Characteristics
Brightness Gain
 Ability of the II tube to increase the illumination level of the image.
 BG deteriorates as II Tube ages.
 Ranges from 5000-30000.
 Minification gain: Increase in image brightness that results from
reduction in image size from the input phosphor to the output
phosphor.
 Minification gain does not change the contrast of the image makes the
image brighter , does not improve the quality of image.
Brightness Gain = (Minification gain) x (Flux-gain) where,

Minification Gain=(Diameter of Input phosphor)2/(Diameter of output

phosphor)2 = (Din/Dout)2
 II Tube Performance/Characteristics

Flux Gain (Electronic gain)-:

 Number of light photons emitted from the output phosphor
compared to number of light photons produced in the input
phosphor.
 Flux gain increases brightness of image by a factor of approx. 50.
 For each light photon from the input screen 50 light photons are
emitted by the output screen.
Flux-gain=(no of output light photons)/(no of input light photons)
 II Tube Performance/Characteristics

Conversion Factor:
 Ratio of output phosphor illumination to the input exposure rate.
 Brightness gain/ Intensification factor
 10 to 30 Cd/m2 per μGy/s..
Conversion Factor ={output phosphor illumination (Cd/m2)}/{input
exposure rate(mR/s)}
 Multifield II Tubes
 Attempts to resolve the conflicts between image size & quality.
 Operated in several modes, including the 4.5 inch, a 6 inch, or a 9 inch
mode.
 9 inch mode is used to view large anatomic areas with minified image.
 4.5 inch or 6inch mode produces magnified resultant dim image. ,
minification gain reduced and maintained with increased mA
determined by ABC that increases spatial resolution.
 Field size is changed by a simple electronic principle: the higher the
voltage on the electrostatic focusing lens, the more the electron beam is
focused.
 Greater voltage to electrostatic lenses:
– Increases acceleration of electrons
– Shifts focal point away from anode
– Used to enlarge small structure or to penetration through larger parts
Multifield II Tubes

Portion of image that remains

unfocussed results in
Vignetting-
Reduction in the brightness at
the periphery of image.
 Automatic Broghtness Control

Automatic Brightness Control- ABC

 When the ABC mode is selected, the ABC circuitry controls the
X-ray intensity measured at the Image-Intensifier so that a
proper image can be displayed on the monitor.
 ABC mode was developed to provide a consistent image
quality during dynamic imaging
 The ABC compensates brightness loss caused by by
generating more X-rays (increasing mA) and/or producing
more penetrating X-rays (increasing kVp).
 Conversely, when the image is too bright, the ABC
compensates by reducing mA and decreasing kVp.
Fluoroscopic Imaging Chain
 Viewing the Fluoroscopic Image

Coupling to the Image Intensifier.

 Image intensifiers and television camera tubes are manufactured so
that the output phosphor of the image-intensifier tube is the same
diameter as the window of the television camera tube, usually 2.5
or 5 cm.
 Two methods are commonly used to couple the television camera
tube to the image-intensifier tube
 Fibre optic coupling
 Lens Couling
 These system transmits the output of the image intensifier to the
light sensitive area of the video camera
 Viewing the Fluoroscopic Image

Television Monitoring
 With the television monitoring system of a fluoroscopic image,
the output phosphor of the image-intensifier tube is coupled
directly to a television camera tube.
 Brightness level and contrast can be controlled electronically.
 Several observers can view the fluoroscopic image at the same
time.
 Allows for storage of the image in its electronic form for later
playback and image manipulation.
Viewing the Fluoroscopic Image
 Viewing the Fluoroscopic Image

Fibre optic coupling

 Uses fiber optic cables thus reducing light loss from the II to video
camera
 Simplest compact method.
 Prevents any additional accessories being used.
 Preserves better spatial resolution
 Cannot accommodate the additional optics required for devices such
as cine or photospot cameras.
 To accept a cine or photospot camera, lens coupling is required.
 Viewing the Fluoroscopic Image
Lens coupling
 Objective lens accepts light from the output phosphor and converts it into a
parallel beam.
 When an image is recorded on film, this beam is interrupted by a beam-splitting
mirror so that only a portion is transmitted to the television camera; the
remainder is reflected to a film camera.
 Allows the fluoroscopist to view the image while it is being recorded.
 Beam-splitting mirror is retracted from the beam when a film camera is not in
use.
 Both the television camera and the film camera are coupled to lenses that focus
the parallel light beam onto the film and target of the respective cameras. Results
in a much larger assembly that should be handled with care.
 Lenses and the mirror remain precisely adjusted because malposition results in a
blurred image.
 Accepts a cine or photospot camera
Viewing the Fluoroscopic Image
 Viewing the Fluoroscopic Image

Closed-circuit Television System

 Used to view the image intensifier output light image converting
into electronic video signal.
 Consists of
1)Television camera
2) Camera control unit
3) TV Monitor
 Allows for real-time viewing of the fluoroscopic image by several
people at once from one monitor or multiple monitors.
 Viewing the Fluoroscopic Image
Television Camera --CCD: Semiconductor, not
Output phosphor is directly a tube
coupled to a TV camera.  Television camera tube or CCD
--Plumbicon Tube : converts the light signal from
Cheapest / Compact / Laggy the output phosphor to an
electronic signal.
--Vidicon: Enhanced vidicon
/ less lag

Fig; Variations of a vidicon television

camera tube
 Viewing the Fluoroscopic Image
Television Camera Tube a) Glass face plate assembly
The basic video camera consists b) Signal plate (thin transparent
film of graphite.)
of
c) Target
1) Vacuum tube cylinder
(approximately 15 mm in diameter
and 25 cm length) surrounded by
electromagnetic focusing coils ,2
pairs of electrostatic deflecting
coils.
2) Photoconductive target
assembly
3) Scanning electron beam
 Target assembly:
 Viewing the Fluoroscopic Image

Television Camera Tube: Target Section

 Functionally most important in tube.
 Thin film of photoconductive material, antimony trisulfide
suspended as globules in mica matrix.
 The optical coupling lens focuses the image intensifier output
image onto the target, forming a charge image within the
photoconductive layer.
 This latent image is read out by the electron beam, which scans
across the target in a series of horizontal raster lines.
 As the scanning electron beam moves across the target, a current
signal is produced that represents the two-dimensional image as a
continuous series of raster lines with varying voltage levels.
 Viewing the Fluoroscopic Image

Vidicon tubes use antimony trisulfide (Sb2S3) (photo-conductive) while

Plumbicon use lead oxide (PbO) in mica matrix
Viewing the Fluoroscopic Image

Vidicon tubes replaced by CCDs

 Video Signal

 When Photoconductive globules absorbs light , photoelectrons are

emitted
 The globule becomes positively charged.
 When the electrons in beam neutralize the positive charge in the
globules , the electrons on the signal plate leave the plate via
resistor.
 These moving electrons forms a current flowing through a resistor
and voltage across the resistor
 This voltage ,when collected for each neutralized globule,
constitutes the video signal.
Video Signal
 TV Monitor

 Convert electronic information from camera into visual information.

 The video signal from the camera tube is amplified & transmitted by
cable to the TV monitor & transformed back on to a visible image.
 TV monitor forms one end of a closed circuit TV system, & the other
end is the TV camera tube or Charged coupled device (CCD).
 Construction of TV monitor: CRT & associated circuits (TV picture
tube, Control grid, electron gun, coils etc).
 The video signal received by the TV picture Tube is modulated –
change in quantity or signal.
 TV Monitor

 Control grid- Receives video signal from Camera control unit ,

uses this signal to regulate the no. of electrons in electron beam
 Anode –carries higher potential (10,000V) accelerates the electron
beam to much higher velocity
 The electron Strike the fluorescent screen ,emit large number of
visible light photons that constitutes the image.
 Nowadays: LCD/LED Monitors and Plasma Display Panel (PDP) .
TV Monitor
 Fluoroscopic TV Image

TV IMAGE
 TV Image is similar to a screened print.
 Made up of mosaic of hundreds of thousands of tiny dots of
different brightness.
 Each dots contributes a minute bit to the total picture.
 When viewed from a distance , the individual dots disappear ,
but at close range or with magnification, they are clearly
visible.
 Recording the Fluoroscopic Image

 Two modes of recording the fluoroscopic image –

1)Light image from output phosphor of II recorded on film with a
Photospot camera or cine camera (Static Images)

2) Electrical signal generated by TV camera recorded by Video Tape

Recording (magnetic tape, Magnetic discs & optical discs).
Recording the Fluoroscopic Image
 Recording the Fluoroscopic Image
SPOT FILM DEVICES:
 Fluoroscopic systems designed for gastrointestinal imaging are generally
equipped with a spot film device.
 Allows exposure of a conventional screen-film cassette in conjunction with
fluoroscopic viewing. This rather familiar system, located in front of the image
intensifier, accepts the screen-film cassette and "parks" it out of the way during
fluoroscopy
 Cassettes may be loaded from the front or rear depending on the design of the
system.
 The x-ray field size is also reduced automatically by the collimators at the time of
exposure to minimize scattered radiation and patient radiation dose.
 The fluoroscopist can override this automatic collimation to further reduce the x-
ray field.
 Spot film imaging uses essentially the same technology as conventional screen-
film radiography.
 Recording the Fluoroscopic Image
SPOT FILM DEVICES:
 Differences and limitations of spot film imaging compared with general
radiography.
 One major limitation is the range of film sizes available for spot film
imaging. Although some older fluoroscopy equipment is limited to a single
size, usually 24 x 24 cm, current equipment allows a range of film sizes to
be used, from 20 x 25 cm to 24 x 35 cm.
 Spot film devices usually allow more than one image to be obtained on a
single film.
 Formats typically include one, two, three, four, or six images on a film.
 Moving closer to the patient reduces the amount of magnification and
decreases the patient radiation dose.
 Recording the Fluoroscopic Image

AUTOMATIC FILM CHANGERS

 The automatic film changers used in vascular imaging are also screen-film systems.
 They can be found in several varieties. Some are large, floor-mounted boxes, but
systems more commonly used today mount on the image intensifier.
 The system consists of a supply magazine for holding unexposed film, a receiving
magazine, a pair of radiographic screens, and a mechanism for transferring the film.
 When an exposure is required, the screens are mechanically separated, the film is
pulled into place between them, and they are closed.
 After the film is exposed, the screens separate again.
 The film is moved to the receiver, and another film is pulled into place for the next
exposure.
 The number of films and filming rates must be preprogrammed for proper operation.
 Recording the Fluoroscopic Image

Photospot camera
 Records the the image output of an II on a film
 Film – role film/cut film(10 cm)
Advantage
 Reduction in pt exposure
 Film does not have to be changed b/w exposures
 Exposure times are shorter-motion is less likely problem
 Films can be taken more rapidly
 Possible to record & view image at same time
 Recording the Fluoroscopic Image

Framing with spot film cameras:

 Framing –Utilisation of available area on film
 The output phosphor of II tube is round, shape of film is square
 4 framing patterns
 Exact framing
 Equal area framing
 Mean diameter framing
 Total area framing
 Equal area framing or mean diameter framing is recommended for
most clinical situations.
 Recording the Fluoroscopic Image

Cineflourography
 Process of recording fluoroscopic images on movie (cine) film
 Two film sizes- 16 mm, 35 mm
 Cine camera-components are lens, iris diaphragm, shutter,
aperture, pressure plate, pull down arm & film transport
mechanism
 Recording the Fluoroscopic Image

MAGNETIC TAPE RECORDERS

 Used for both recording and playback.
 Designed to show motion, comparable to a movie camera.
 Used to show a single frame by stopping tape against the
revolving drum.
 Receives a video signal from the camera control unit for recording
& for playback , it transmits signal to one or more TV monitors.
 Both these transmissions are conducted through cables, so it is
called closed circuit system.
 The image is stored on wide polyster base Tape, coated on one
side with a magnetic film.
 Recording the Fluoroscopic Image

MAGNETIC DISC RECORDERS

 Works on similar principle as that of the tape recorders, but
they have different functions.
 Designed to show stationery images & to stop action., more
like a spot film camera.
 Discs looks like phonograph records.
 Magnetic disc used in radiology have a bandpass
limitations(about 5 MHz).
 Every computer in the world has a magnetic disc recorder
associated with it.
 Recording the Fluoroscopic Image

OPTICAL DISC RECORDERS

 Current technology centres on the optical WORM(Write Once Read Many
Times) discs, but erasable optical discs are now commercially available.
 WORM discs begin with a rigid substrate such as glass, aluminium or
plastic.
 Photoactive recording medium is coated on the substrate.
 Recording is accomplished by marking or burning an indentation on the
photoactive layer using a laser source,
 Readout depends on reflection or scattering of light by these defects in
the photoactive layer.
 Storage capability of the disc is determined by the size of the focussed
laser beam and the ability to space adjacent tracks close to each other.
 TV Image Quality

 Resolution
-Horizontal Resolution
-Vertical Resolution
 Electronic Noise
 Contrast
 Lag
 TV Image Quality
HORIZONTAL RESOLUTION
 Limited by factors such as frequency bandwidth of the video system.
 Concept of video bandwidth can be explained by drawing an analogy
with the stereo systems that many peoples have in their homes.
 This analogy can be extended to the video systems by imaging a
low pass filter at the end of the amplifier chain that transmits the
signal from the camera to the monitor.
 If the bandwidth is too low, a rounded –off blurry representation of
the gauge will be passed to the video monitor.
 If the bandwidth is too high ,there is a great deal of electronic
noise ,generated by the video system at high frequencies.
 TV Image Quality

HORIZONTAL RESOLUTION
 Dictated by the number of video lines.
 Since ,the electron beam spot in the pick up tube is not pill-
box shaped (with sharp edges ) but tends to be more Gaussian
,resulting in overlap betn the lines(esp. during interlaced
scanning) reduces the vertical resolution.
 Also affected by the raster employed.

Note: The appropriate bandwidth is the one that yields the

horizontal resolution equal to the vertical resolution.
 TV Image Quality

ELECTRONIC NOISE
 Since ,the output phosphor of an II tube may exhibit quantum
noise & structure mottle ,it reduces sharpness of the final
image.
 The TV system itself produces noise during the electronic
amplification of the weak video signal from the pick up tube
& degrades the quality of the image.
 This produces on the TV monitor screen a “ Snowstorm”
effect similar to quantum noise.
 TV Image Quality

CONTRAST
 Contrast of the image on a TV camera depends on the contrast of
the original image focused onto the signal plate of the TV pick up
tube.
 Contrast adjustments cause a change in average screen luminences
i.e. reducing the contrast setting also causes a reduction in image
brightness & a compensatory adjustment to the brightness control is
required to maintain a satisfactory image.
 Distortion of contrast occurs in TV pick up tubes unless they
produce a dark current.
 TV image contrast is also affected by the ambient lighting
conditions.
 TV Image Quality

LAG
 Term used to describe the inability of an imaging system to follow
rapid changes in its output image.
 Refers to the condition in which the video signal output rises or
falls to the new value more slowly than the changing light input.
 Undesirable property of most Vidicon tubes ,which becomes apparent
when the camera is moved rapidly results in the blurring of the
image.
 Is signal dependent i.e. it is much higher in the dark parts of the
image than in bright parts.
 CCD cameras has no lag.
TV Image Quality
 Digital Fluoroscopy

 Similar to image-intensified fluoroscopy, digital fluoroscopy has

evolved over time.
 Early versions of digital fluoroscopy used an image-intensified
fluoroscopic chain but added an analog-to-digital converter (ADC)
and a computer between the TV camera and the monitor.
 Once in digital form, the image can be post-processed and stored in
that format or printed onto film using a dry laser printer.
 Recent advancement in digital fluoroscopy-introduction of a flat-
panel detector in place of an image intensifier
Digital Fluoroscopy
 Digital Fluoroscopy
Advantages of Digital Fluoroscopy over Conventional Fluoroscopy
Digital Advantages:
 Quicker Image acquisition
 LIH
 Post processing:
 Alteration of brightness and contrast
 Windowing
 Low Radiation dose (Probable)

Specific Advantages:
 Pulsed Progressive Fluoroscopy:
 High mA Mode- risk of tube over load avoided by pulsed mode, reduced exposure time per
pulse creating frames
 Short Tube interrogation and extinction time
 Temporal Frame averaging:
 Averaging displayed image with previous frame
 Decrease image noise. Works well for static imaging but increased image lag unacceptable for
dynamic studies
 Digital Fluoroscopy

Operating Modes
i) Continuous Fluoroscopy
 the most basic form of fluoroscopic imaging
 X-ray beam is constantly on.
 A frame rate of 25 or 30 fps yields a frame integration time of 40 or
33 msec, which can lead to blurring of moving objects
ii) Pulsed Fluoroscopy
 Short Pulses of X-rays used.
 Pulsed fluoroscopy can be accomplished either by
a) Operating the Generator in pulsed mode.
b) Using a Grid-Controlled or Grid-Switched XRT.
 Digital Fluoroscopy

Operating Modes
Pulsed Fluoroscopy
 Lower radiation dose when fluoroscopic frames are acquired in a
fraction of the time used in continuous operation.
 X-ray production is needed only immediately prior to the Readout
of the video camera.
 Improved Image Quality owing to reduction in motion blur because
of the reduced integration time.
 Pulsed mode operation freezes the motion of objects in the image,
resulting in sharper images and improved image quality.
 Reduced tube loading owing to a lower duty cycle as low as 5-8%.
 Digital Fluoroscopy

 Interrogation time-Time required for the X-ray tube to be

switched on and reach selected levels of kVp and mA.
 Duty Cycle - Fraction of time that the X-ray tube is
energized.
 Extinction time - time required for the X-ray tube to be
switched off.

 Must have interrogation time and extinction times of less

than 1 ms.
 Digital Fluoroscopy

 A major change from conventional fluoroscopy to Digital

fluoroscopy is the use of a charge-coupled device (CCD) instead
of TV camera pickup tube.
 The Sensitive component is a layer of crystalline silicon.

When silicon is illuminated, electrical charge is generated,

which is then sampled, pixel by pixel, and manipulated to
produce a digital image.
 Digital Fluoroscopy-FPIR
 Next improvement in DF is quick development of Flat Panel Image
Receptors (FPIRs).
 Faster than the time it takes for all television camera tubes to be replaced
by CCDs, CCDs will begin to be replaced by FPIRs.
 Composed of Cesium Iodide (CsI)/Amorphous Silicon(a-Si) or
Amorphous Selenium (a-se).
 Two types:
o Indirect Conversion FPIR: Cesium Iodide (CsI)/Amorphous

Silicon(a-Si).
o Direct Conversion FPIR: Amorphous Selenium (a-se)
 Digital Fluoroscopy
 FPIR is much small and lighter and is manipulated more easily
than an image intensifier.
 FPIR imaging suite provides easier patient manipulation and
radiologist/technologist movement.
 No radiographic cassettes.
 Image Intensifier is limited by non-uniform spatial resolution and
contrast resolution form the center to periphery of the circular
image and Veiling glare and pincushion distortion increase with the
age but the response of an FPIR is uniform over the entire receptor
and does not degrade with age.
 The image captured by an FPIR is square or rectangular similar to
the associated flat panel monitors.
 Digital Fluoroscopy
 CsI/a-Si is an indirect DF process by which
X-rays are converted first to light by CsI
and then to electrical signal by a-Si.
 The image receptor is fabricated into
individual pixels which has light sensitive
face of a-Si with a capacitor and a TFT
embedded in it.
 Digital Fluoroscopy
 Amorphous Selenium is the direct DF process
by which X-rays are converted to electric
signal as no scintillation phosphor is involved.
 The imaging forming X-ray beam interacts
directly with a-Se producing a charged pair.
 a-Se is both the capture element and the
coupling element.
 a-Se is approx. 200 m thick and is sand-
wiched between charged electrodes.
 X-rays incident on a-Se create electron hole
pairs through direct ionization of Selenium.
 The created charge is collected by a storage
capacitor and remains there until the signal is
read by the switching action of the TFT.
 Digital Fluoroscopy
 The geometry of each individual pixel is very
important as a portion of the pixel face is occupied
by conductors, capacitors and TFT.
 It is not totally sensitive to the incident image
forming X-ray beam.
 The percentage of the pixel face that is sensitive to
X-rays is the fill factor, which is approximately
80%; therefore 20% of the X-ray beam does not
contribute to the image.
 This represents one of the dilemmas for Digital
Imaging.
 As the pixel size is reduced, spatial resolution
improves but at the expense of the patient
radiation dose.
 With smaller pixels, the fill factor is reduced and
the X-ray intensity must be increased to maintain
adequate signal strength.
Digital Fluoroscopy
Digital Fluoroscopy
 Digital Fluoroscopy
 Flat Panel Display technology is rapidly replacing the Cathode Ray Tube
(CRT) in all applications like Television, Computer.
 Radiography and fluoroscopy is the similar field in which CRTs are rapidly
being replaced by the Flat Panel Image Display.
 In fluoroscopic image viewing, Flat Panel Image Display is usually Active
Matrix Liquid Crystal Display (AMLCD)
 A liquid crystal has the property of a highly ordered molecular structure-
a crystal- and the property of viscosity-a fluid.
 Liquid crystals materials are the linear organic molecules that are
electrically charged, forming a natural molecular dipole.
 Consequently, the liquid crystal can be aligned through the action of an
external electrical field.
 Active matrix liquid crystal displays are superior to cathode ray tube
displays.
 Digital Fluoroscopy

Advantages of Flat Panel Image Display

o Superior image quality
o Light in weight

o Easier to view
o Easier to manipulate
o Provide better images
o Can be readily mounted suspended in an angiographic room

o Ergonomic design of digital workstations.