Fluoroscopy

&
Digital Fluoroscopy

P.Ravikumar, Lect./BME
Fluoroscopy system
 Fluoroscopy
• A type of radiographic study
• Provides a dynamic imaging source
• Allows the observer to visualize motility of
organs
• Films provide a static image
• Contrast media is generally used in
conjunction with fluoroscopy
• Static images are obtained on a spot film
 History Of Fluoroscopy
• Invented in 1896 by Thomas Edison
• Original phosphor was zinc-cadmium sulfide
• The screen was placed above the patient, the image was
observed by viewing the screen
• Dark adaptation was necessary to view images
• This type of fluoroscopy was adapted to mirror optics but
only one person could view at a time
• In the 1950’s, image intensification was developed
• In the 1990’s, digital fluoroscopy was developed and is
widely used today
Conventional Fluoroscopy
 Two types of Fluoroscopy are:
• under-couch tube design
• over-couch tube design
• Over-couch tube design offers a greater distance
between tube and both patient and intensifier.
– This improves image quality by reducing geometric
unsharpness and reduces radiation skin dose to the
patient.
• Under-couch tube design provides direct fluoroscopy
screen and there for allows operator to be close to
the patient.
 Illumination During Fluoroscopy
• Fluoroscopy is generally visualized in dimly lit
rooms
• Capable of limited brightness levels
• Image-intensified fluoroscopy is much brighter
than conventional fluoroscopy
• Illumination levels are measured in lamberts
• II levels are about the same brightness as
viewing radiographic films
 FLUOROSCOPIC DATA AQUSITION-IMAGE
INTENSIFIED SYSTEM

1. X-RAY TUBE
2. PATIENT
3. IMAGE INTENSIFIER
4. OUTPUT PHOSPHOR
5. CAMERA (Viewing system)
6. MONITOR
 Image Intensifier Tube
• Receives remnant radiation
• Converts it to light
• Increases the light intensity
• Similar to x-ray tube
– Contains a vacuum
– Mounted in a metal container to protect it
 Viewing Systems
• Image produced at output phosphor is much
smaller, brighter image
• Could be viewed directly off output phosphor
– Mirror optics
• Finally updated to a television monitor
– Closed circuit monitor system
 Television Camera
• Plumbicon and vidicon are most often used
– Plumbicon - Best for imaging moving organs, i.e., heart
– Vidicon - Best for imaging stationary organs
• A typical vidicon is contained in a glass envelope with
a vacuum
• Internal components:
– Electron gun
• Cathode
– Electrostatic grids
– Target assembly
• Anode
 Television Camera Tube
Steering coils Deviation coil
Alignement coil
Focussing optical lens Photoconductive layer Accelarator grids
Input plate Control grid

Electron beam

Iris
Video Signal

Electron gun
Signal electrode Field grid Electrode
Television Camera Tube - Working
• Light image from II is converted to electric
signal
• Varying light intensity is received at target
assembly
• Electrons are emitted - number depends on
light intensity received by the target assembly
• The electron gun supplies electrons to fill any
deficiency
Television Camera Tube - Working
• This causes a current to flow
• Causes a varying voltage across the tube
• This is the video signal
• The video signal pulses are reassembled into a
visible image by the image monitor
 TV camera and video signal
• This scanning electron beam moves across the surface of the TV
camera tube in a series of lines.
• This is achieved by a series of external coils, which are placed on
the outside of the camera tube. In a typical television system,
the image is formed from a set of 625 lines. On the first pass
the set of odd numbered lines are scanned followed by the even
numbers. This type of image is called interlaced.
• The purpose of interlacing is to prevent flickering of the
television image on the monitor, by increasing the apparent
frequency of frames (50 half frames/second).
• In Europe, 25 frames are updated every second.
 Different types of scanning
11
1
INTERLACED
13 12 SCANNING
3 2
15 14
5 4
17
625 lines in 40 ms
16 i.e. : 25 frames/s
7 6
19 18
9 8
21 20
10
1 2
3 4
5 6
7 8 PROGRESSIVE
9 10 SCANNING
11 12
13 14
15 16
17 18
 Image or TV Monitor
• The final component in the II system
• Converts the varying voltage from the Vidicon
into a visible image
• Elements of the TV Monitor
– Cathode ray tube
– Electron gun
– Focusing coils
– Control grids
Television Monitor Tube
 Image Monitor (Continued)
• Electron gun emits electron toward a
fluorescent screen, (TV screen) of the monitor
• Electrons emitted are in synchronicity with the
signal being emitted by vidicon
 Coupling Of The Television Camera
with Image Intensifier
• Two methods:
• Fiber optics
– Cassette loaded spot films are necessary
• Lens coupling
– Cine
– Spot film camera
Recording The Fluoroscopic Image
• Dynamic Systems
– Cine film systems
– Videotape recording
• Static Systems
– Cassettes
– Spot film camera
– Video recorders
– Digital fluoroscopy
 Cine Film Systems
• Uses a 16 - 35mm movie camera
• Image quality is better with 35mm
• Patient dose is higher with 35mm
• Patient dose is higher with cine than regular
fluoro - requires higher mA
• Cine camera is driven by an electronic
synchronous motor
 Videotape Recording
• Can record image from TV monitor
• Uses VHS ½ in. or U-matic ¾ in recorder
• Does not exhibit high resolution
• Can provide instant playback of examination
• Does not provide additional dose to patient
 Cassettes
• High image quality
• High patient dose
• Delay of two seconds is required before
cassette can be exposed
• Multiple images can be exposed on one
cassette
• Provides a familiar format, therefore, most
popular
 Spot Film Cameras
• Also called millimeter and photospot cameras
• Similar to movie cameras, but only expose one frame
• Image comes directly from output phosphor
• This requires less heat loading, lower mA, shorter
interruption of exam
• Used with a beam splitting mirror
• Available in 70 and 105mm
• 70 mm can expose up to 12 frames/sec
 Video Recorders
• Uses a magnetic disk
• Usually records single frames
• Has a playback mode
 Viewing System – Over all
• Output screen image can be transferred to different
optical displaying systems:
– conventional TV
• Generating a full frame of 525 lines (in USA)
• 625 lines and 25 full frames/s up to 1000 lines (in Europe)
• interlaced mode is used to prevent flickering
– cinema
• 35 mm film format: from 25 to 150 images/s
– photography
• rolled film of 105 mm: max 6 images/s
• film of 100 mm x 100 mm
Digital (Computerized) Fluoroscopy
• Developed in late 70’s
• Images are taken directly from output
phosphor
• A video camera and digital image processor
are used to obtain images
• The image is converted from analog to digital
• A dynamic recording can be made
• Image can be manipulated in many ways
• Less radiation is used
Digital Fluoroscopy Chain of Events
 CCD SYSTEM ADVANTAGE OVER
CAMERA SYSTEM
• LOW LEVEL OF ELECTRONIC NOISE
• HIGH SPATIAL RESOLUTION
• NO LAG OR BLOOMING
• NO MAINTENANCE
• UNLIMITED LIFE
• UNAFFECTED BY MAGNETIC FIELD
• LINEAR RESPONSE
• LOWER DOSE
 Mobile Fluoroscopy
• Can provide both static and dynamic images
• Usually connected to a video disk
• Can do everything that a fixed unit can
• Generally used in critical care areas and
surgery
Mobile Fluoroscopy
Questions…..