Fluoroscopy Systems

IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology
RADIATION PROTECTION IN DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY

L16.1: Optimization of protection in fluoroscopy
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International Atomic Energy Agency
Introduction
Subject matter : fluoroscopy equipment and
accessories Different electronic component contribute to the image formation in fluoroscopy. Good knowledge of their respective role and consistent Quality Control policy are the essential tools for an appropriate use of such equipment.
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16.1: Optimization of protection in fluoroscopy 2
Topics
Example of fluoroscopy systems Image intensifier component and
parameters
Image intensifier and TV system
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16.1: Optimization of protection in fluoroscopy
Overview
To become familiar with the components of
the fluoroscopy system (design, technical parameters that affect the fluoroscopic image quality and Quality Control).
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Part 16.1: Optimization of protection in fluoroscopy

Topic 1: Example of fluoroscopy systems
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Fluoroscopy: a see-through operation with motion

Used to visualize motion of
internal fluid, structures Operator controls activation of tube and position over patient Early fluoroscopy gave dim image on fluorescent screen Modern systems include image intensifier with television screen display and choice of recording devices
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Fluoroscopy
X-ray transmitted trough patient The photographic plate replaced by fluorescent screen Screen fluoresces under irradiation and gives a live
image Older systems direct viewing of screen 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 Fluoroscopy often used to observe digestive tract
Upper GI series, Barium Swallow Lower GI series Barium Enema IAEA
Direct Fluoroscopy: obsolete
In older fluoroscopic examinations radiologist stands behind screen and view the picture Radiologist receives high exposure; despite protective glass, lead shielding in stand, apron and perhaps goggles
Main source of staff exposure is NOT the patient but direct beam
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Older Fluoroscopic Equipment

(still in use in some countries)
Staff in DIRECT beam
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Direct fluoroscopy
AVOID USE OF DIRECT FLUOROSCOPY Directive 97/43Euratom Art 8.4. In the case of fluoroscopy, examinations without
an image intensification or equivalent techniques are not justified and shall therefore be prohibited. Direct fluoroscopy will not comply with BSS performance of diagnostic radiography and fluoroscopy equipment and of nuclear medicine equipment should be assessed on the basis of comparison with the diagnostic reference levels
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Modern Image Intensifier based fluoroscopy system
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Modern fluoroscopic system components
Display control
Automatic control display brightness radiation dose film exposure Timer
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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.
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Different fluoroscopy systems

Interventional radiology systems
Requires specific safety considerations.
In interventional radiology the physician can be near the patient during the procedure.
Multipurpose fluoroscopy systems

Can be used as a remote control system
or as a system to perform simple interventional procedures
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Topic 2: Image Intensifier component and parameters
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The image intensifier (I.I.)

I.I. Input Screen Electrode E1 Electrode E2 Electrode E3
I.I.Output Screen
Photocathode
+
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Image intensifier systems
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Image intensifier component

Input
1
screen: conversion of incident X Rays into light photons (CsI)

X Ray photon creates 3,000 light photons
Photocathode:
only
conversion of light photons into electrons
10 to 20% of light photons are converted into photoelectrons
Electrodes Output
: focusing of electrons onto the output screen

provide the electronic de-magnification
electrodes
screen: conversion of accelerated electrons into light photons
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Image intensifier parameters (I)

Conversion
coefficient (Gx): the ratio of the output screen brightness to the input screen dose rate Gx = cd.m-2Gys-1
Gx depends on :
the
the
applied tube potential

diameter () of the input screen input screen () of 22 cm Gx = 200 input screen () of 16 cm Gx = 200 x (16/22)2 = 105 input screen () of 11 cm Gx = 200 x (11/22)2 = 50
I.I. I.I. I.I.
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Image intensifier parameters (II)

Brightness Uniformity: the input screen brightness
may vary from the center of the image intensifier to the periphery
Uniformity = (Brightness(c) - Brightness(p)) x 100 / Brightness(c)
Geometrical distortion: all X Ray image intensifiers

exhibit some degree of pincushion distortion. This is usually caused by a local magnetic field.
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Image distortion
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Image intensifier parameters (III)

Spatial
resolution limit: the value of the highest spatial frequency that can be visually detected
it
provides a sensitive measure of the state of focusing of a system
it
is quoted by manufacturer and usually measured optically and under fully optimized conditions. This value correlates well with the high frequency limit of the Modulation Transfer Function (MTF) can be assessed with a resolution pattern which contains several sets of patterns at various frequency
it
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Line pair gauges
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Line pair gauges

GOOD RESOLUTION POOR RESOLUTION
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Image intensifier parameters (IV)
Overall image quality - threshold contrast-detail detection

X Ray, electrons and light scatter process in an I.I. can result in a significant loss of contrast of radiological detail. The degree of contrast exhibited by an I.I. is defined by the design of the image tube and coupling optics.
Spurious sources of contrast loss are:

accumulation reduction aging
of dust and dirt on the various optical surfaces
in the quality of the vacuum
process (deterioration of phosphor screen)
Sources of noise are:

X
Ray quantum mottle processes, film granularity, film processing
photon-conversion
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Image intensifier parameters (V)

Overall image quality can be assessed using a suitable
threshold contrast-detail detectability test object which comprises an array of disc-shaped metal details and gives a range of diameters and X Ray transmission Sources of image degradation such as contrast loss, noise and unsharpness limit the number of details that are visible. If performance is regularly monitored using this test, any sudden or gradual deterioration in image quality can be detected as a reduction in the number of low contrast or small details.
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Overall image quality
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Topic 3: Image Intensifier and TV system
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Image intensifier - TV system

Output
screen image can be transferred to different optical displaying systems:

conventional TV
262,5
odd lines and 262,5 even lines 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
Cine
35
film
mm film format: from 25 to 150 images/s
photography
roll
film,105 mm: max 6 images/s film of 100 mm x 100 mm
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X Ray TUBE
kV
FILM
PM VIDICON
REFERENCE CONTROLLER kV
GENERAL SCHEME OF FLUOROSCOPY

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X Ray TUBE
kV
CINE MODE
I2 I1
CONTROLLER
I3
FILM
PM VIDICON
C1
C2
Ref.
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Type of TV camera
VIDICON TV camera
improvement
of contrast improvement of signal to noise ratio high image lag
PLUMBICON TV camera (suitable for cardiology)

lower
image lag (follow up of organ motion) quantum noise level
higher
CCD TV camera (digital fluoroscopy)

digital
fluoroscopy spot films are limited in resolution, since they depend on the TV camera (no better than about 2 c/mm) for a 1000 line TV system
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TV camera and video signal (I)

The output phosphor of the image intensifier is
optically coupled to a television camera system. A pair of lenses focuses the output image onto the input surface of the television camera. Often a beam splitting mirror is interposed between the two lenses. The purpose of this mirror is to reflect part of the light produced by the image intensifier onto a 100 mm camera or cine camera. Typically, the mirror will reflect 90% of the incident light and transmit 10% onto the television camera.
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TV camera and video signal (II)

Older fluoroscopy equipment will have a television
system using a camera tube. The camera tube has a glass envelope containing a thin conductive layer coated onto the inside surface of the glass envelope. In a PLUMBICON tube, this material is made out of lead oxide, whereas antimony trisulphide is used in a VIDICON tube.
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Photoconductive camera tube

Steering coils Focussing optical lens Photoconductive layer Deviation coil Alignement coil
Accelarator grids
Control grid
Input plate
Electron beam
Iris
Video Signal
Signal electrode
Electron gun Field grid Electrode

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TV camera and video signal (III)

The surface of the photoconductor is scanned with
an electron beam and the amount of current flowing is related to the amount of light falling on the television camera input surface. The scanning electron beam is produced by a heated photocathode. Electrons are emitted into the vacuum and accelerated across the television camera tube by applying a voltage. The electron beam is focussed by a set of focussing coils.
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TV camera and video signal (IV)

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.
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Different types of scanning

1 13 3 15 5 17 7 19 9 21 10 1 3 5 7 9 11 13 15 17 2 4 6 8 10 12 14 16 18 11 12 2 14 4 16 6 18 8 20
INTERLACED SCANNING
625 lines in 40 ms i.e. : 25 frames/s
PROGRESSIVE SCANNING
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TV camera and video signal (V)

On most fluoroscopy units, the resolution of the
system is governed by the number of lines of the television system. Thus, it is possible to improve the high contrast resolution by increasing the number of television lines. Some systems have 1,000 or 2,000
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TV camera and video signal (VI)

Many modern fluoroscopy systems used CCD (charge
coupled devices) TV cameras. The front surface is a mosaic of detectors from which a signal is derived. The video signal comprises a set of repetitive synchronizing pulses. In between there is a signal that is produced by the light falling on the camera surface. The synchronizing voltage is used to trigger the TV system to begin sweeping across a raster line. Another voltage pulse is used to trigger the system to start rescanning the television field.
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Schematic structure of a charged couple device (CCD)
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TV camera and video signal (VII)

A series of electronic circuits move the scanning
beams of the TV camera and monitor in synchronism. This is achieved by the synchronizing voltage pulses. The current, which flows down the scanning beam in the TV monitor, is related to that in the TV camera. Consequently, the brightness of the image on the video display is proportional to the amount of light falling on the corresponding position on the TV camera.
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TV image sampling
HEIGHT 512
IMAGE 512 x 512 PIXELS

WIDTH 512 ONE LINE
VIDEO SIGNAL (1 LINE)
64 s IMAGE LINE 52 s
DIGITIZED SIGNAL
SYNCHRO
12 s SAMPLING
SINGLE LINE TIME
LIGHT INTENSITY
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Digital radiography principle
ANALOGUE SIGNAL
ADC
Memory
t
DIGITAL SIGNAL
Iris
Clock
See more in Lecture L20

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Digital Image recording

In newer fluoroscopic systems film recording is
replaced with digital image recording. Digital photospots are 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.
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TV camera and video signal (VIII)

It is possible to adjust the brightness and
contrast settings of the TV monitor to improve the quality of the displayed image.
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Summary
The main components of the fluoroscopy
imaging chain and their role are explained:
Image Intensifier
Associated image TV system
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Where to Get More Information

The Essential Physics of Medical Imaging.
JT Bushberg, JA Seibert, EM Leidholdt, JM Boone. Lippincott Williams & Wilkins, Philadelphia, 2011 The physics of diagnostic imaging, Dowsett et al, Hodder Arnold, 2006 Interventional Fluoroscopy: Physics, Technology, Safety, S. Balter, Wiley-Liss, 2001
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Fluoroscopy Systems

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IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

RADIATION PROTECTION IN DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY

Image intensifier and TV system

16.1: Optimization of protection in fluoroscopy

16.1: Optimization of protection in fluoroscopy

IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 16.1: Optimization of protection in fluoroscopy

Fluoroscopy: a see-through operation with motion

16.1: Optimization of protection in fluoroscopy

Direct Fluoroscopy: obsolete

16.1: Optimization of protection in fluoroscopy

Older Fluoroscopic Equipment

Staff in DIRECT beam

16.1: Optimization of protection in fluoroscopy

Modern Image Intensifier based fluoroscopy system

16.1: Optimization of protection in fluoroscopy

Modern fluoroscopic system components

Automatic control display brightness radiation dose film exposure Timer

16.1: Optimization of protection in fluoroscopy

Different fluoroscopy systems

Remote control systems

Different fluoroscopy systems

Multipurpose fluoroscopy systems

16.1: Optimization of protection in fluoroscopy

IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 16.1: Optimization of protection in fluoroscopy

The image intensifier (I.I.)

16.1: Optimization of protection in fluoroscopy

Image intensifier systems

16.1: Optimization of protection in fluoroscopy

Image intensifier component

screen: conversion of incident X Rays into light photons (CsI)

conversion of light photons into electrons

10 to 20% of light photons are converted into photoelectrons

: focusing of electrons onto the output screen

screen: conversion of accelerated electrons into light photons

16.1: Optimization of protection in fluoroscopy

Image intensifier parameters (I)

applied tube potential

I.I. I.I. I.I.

16.1: Optimization of protection in fluoroscopy

Image intensifier parameters (II)

Geometrical distortion: all X Ray image intensifiers

16.1: Optimization of protection in fluoroscopy

Image intensifier parameters (III)

provides a sensitive measure of the state of focusing of a system

Line pair gauges

16.1: Optimization of protection in fluoroscopy

Line pair gauges

16.1: Optimization of protection in fluoroscopy

Image intensifier parameters (IV)

Overall image quality - threshold contrast-detail detection

Spurious sources of contrast loss are:

of dust and dirt on the various optical surfaces

in the quality of the vacuum

process (deterioration of phosphor screen)

Sources of noise are:

Ray quantum mottle processes, film granularity, film processing

16.1: Optimization of protection in fluoroscopy

Image intensifier parameters (V)

Overall image quality

16.1: Optimization of protection in fluoroscopy

IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology