Fluoroscopy

Gourav Kumar
Assistant professor
Department of radiology and Imaging Technology
NIMS University, Jaipur Rajasthan
Content

• Working Principle
• Components of fluoroscopy
• Image Intensifier Tube
components
• Image Intensifier
• Input Phosphor
material
• Output Phosphor
material
• Image Monitoring
• Different Fluoroscopy
systems
 Working Principle

• X-ray transmitted through patient

• The photographic plate replaced by fluorescent screen

• Screen fluoresces under irradiation and gives a life picture

• Older systems direct viewing of screen nowadays screen part of an Image

Intensifier system coupled to a television camera

• Radiologist can watch the images “live” on TV- monitor; images can
be recorded

• The primary function of a fluoroscope is to perform dynamic studies;

that is, the fluoroscope is used to visualize the motion of internal
structures and fluids.
• Radiologist can watch the images “live” on TV- monitor; images can be
recorded

• The primary function of a fluoroscope is to perform dynamic studies;

that is, the fluoroscope is used to visualize the motion of internal
structures and fluids

• The purpose of this technique is to get real-time and moving images of

the insides of a person by way of the fluoroscope.
• If something is observed that the radiologist would like to preserve for
later study, a radiograph can be made with little interruption of
fluoroscopic examination. Such a radiograph is known as spot film.
• During fluoroscopy the x-Ray tube is operated at less than 5mA.
Normally 2 to 4mA.
Components of Fluoroscopy
• x-ray generator
• x-ray tube
• collimator
• filters
• patient table
• grid
• image intensifier
• optical coupling
• television system
• image recording
Image Intensifier Tube
Components
• Glass envelope
• Input phosphor
• Photocathode
• Electrostatic focusing lenses
• Output phosphor
Image
Intensifier
• The image intensifier is a complex electronic device that receives the remnant
X-
Ray beam, converts it into light, and increases the light intensity.
 Contd
…
Input screen: conversion of incident X Rays
into light photons (CsI)
*1 X Ray photon creates » 3,000 light
photons
*Photocathode: conversion of light photons
into electrons
* only 10 to 20% of light photons are
converted into photoelectrons
*Electrodes : focalization of electrons onto
the output screen
* electrodes provide the electronic
magnification
*Output screen: conversion of accelerated
electrons into light photons
Contd
…
Glass envelope:

• Maintains tube vacuum to allow control of e’s flow, has no functional part in
image formation.

Input phosphor:

• X-Rays that exit the patient and are incident on the image intensifier tube are
transmitted through the glass envelope and interact with the input phosphor,
which is cesium iodide.

• When X-Rays interacts with the input phosphor, its energy is converted into a
burst of visible light photons as occur on the intensifying screen.
Input Phosphor Materials
• 1st Generation Image Intensifiers
• Input phosphor - Zinc Cadmium Sulfide
• Output phosphor - Zinc Cadmium Sulfide.
• 2nd Generation Image Intensifiers
• Input phosphor- Cesium Iodide (smaller
• crystals with greater packing density - manmade)
• Output phosphor - Zinc Cadmium Sulfide.

• Photocathode:
• It is bonded directly to the input phosphor with a
• thin, transparent, adhesive layer.
• The photocathode is a thin metal layer, usually
• composed of cesium and antimony compounds,
• that respond to stimulation by light with the
• emission of electron. This process is known as
• photoemission.
Electrostatic Focusing
Lenses
Located along length of the tube, responsible for focusing the
electrons across the tube from input to output phosphor. Image
is reversed from input to output phosphor (right becomes left,
superior to inferior). The concave input screen reduces
distortion by keeping the same distance between all points on
the input &output screens.

Anode: Is usually charged with 25 kV and is used to

accelerate e’s across the tube to > kinetic energy and > light
produced. Collects stray e’s as well.
Output
Phosphor
• The output phosphor is usually made up of zinc cadmium
sulfide crystals. Each photoelectron that arrives at the
output phosphor results in approximately 50-70times.
Image
Monitoring
• The principal advantage of image-intensified fluoroscopy
over earlier types of fluoroscopy is increased image
brightness.
• Two methods are used to electronically convert the visible
image on the output phosphor of the image intensifier into
an electronic signal.
1) Thermionic television camera tube
2) The solid state charge-coupled device (CCD).
Contd
…
• The television camera consists of cylindrical housing, approximately 15 mm in
diameter by 25 cm in length, that contains the heart of the camera, TV camera
tube.
• It also contains electromagnetic coils that are used to properly steer the electron
beam inside the tube.
• A number of such television camera tubes are available for television
fluoroscopy, but the vidicon and its modified version, the Plumbicon, are used
most often.
Contd
…
• Two methods are commonly used to couple the television camera tube to the
image-intensifier tube.
Fiber optics.
Lens system.
• The simplest
method is to
use a bundle
of fiber
optics.
• One advantage of this type of coupling is its compact assembly, which makes it
easy to move the image-intensifier tower. This coupling is rugged and can
withstand relatively rough handling.
• The principal disadvantage is that it cannot accommodate the additional
optics required for devices such as cine or photospot cameras.
Lens Coupling &
Working
• To accept a cine or photospot camera, Lens coupling is required. This
type of coupling results in a much larger assembly that should be
handled with care.
• Working: The 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 portion is transmitted to the
television camera; the remainder is reflected to a film camera. Such
systems allows the technologist/Radiologists to view the image while
it is being recorded.
• The video signal is amplified and is transmitted by cable to the
television monitor, where it is transformed back into a visible image
 Contd
•…In newer fluoroscopic systems film recording replaced with
digital image recording.
• Digital photospots acquired by recording a digitized video
signal and storing it in computer memory.
• Operation fast, convenient.
• Image quality can be enhanced by application of various image
processing techniques, including window-level, frame averaging,
and edge enhancement.
• But, the spatial resolution of digital photospots is less than
that of film images.
• It is possible to adjust the brightness and contrast settings of the
TV monitor to improve the quality of the displayed image.
• This can be performed using a suitable test object or
electronic pattern generator.
Different Fluoroscopy
systems:
• Remote control systems
Not requiring the presence of medical specialists inside the X Ray
room
• Mobile C-arms
Mostly used in surgical theatres.
• Interventional radiology systems
Requiring specific safety considerations.
In interventional radiology the surgeon can be near the patient
during the procedure.
• Multipurpose fluoroscopy systems
They can be used as a remote control system or as a system to
perform simple
interventional procedures.
Thank
You