X-Ray (Fluoroscopy)

Toni (36386)
Bobby Rian Dewangga (37994)
Richard Aritonang (38539)
Muhammad Qodar Abdurrahman (38939)
Outline
Definisi X-Ray Floroscopy
Sejarah Fluoroscopy
Komponen Fluoroscopy
Cara Kerja Fluoroscopy
Kegunaan Fluoroscopy
Prosedur Fluoroscopy
Contoh Hasil Fluoroscopy
Kelebihan
Kekurangan
Definisi X-Ray
Definisi :

X-rays are part of the electromagnetic
spectrum, with wavelengths shorter than
visible light. Different applications use different
parts of the X-ray spectrum.
Definisi Fluoroscopy
Definisi :
Fluoroscopy is a diagnostic imaging technique that employs X-rays for
obtaining real-time moving imagery of the internal structure of a patient
through the use of a fluoroscope.
History of X-Ray
Fluoroscopy
William Crookes (English)
(1869-1875)
A Crookes tube (2 views): light and dark.
Electrons travel in straight lines from the
cathode (left), as evidenced by the shadow
cast from the Maltese cross on the
fluorescence of the right hand end. The
anode is at the bottom wire.
Power off. Without magnet, rays
travel straight.
With magnet, rays
are bent down.
Diagram showing a Crookes
tube circuit.
Experimental electrical discharge tube, with partial
vacuum.

In which cathode rays, streams of electrons, were
discovered.


Crookes tube consists of a partially evacuated glass
container of various shapes, with two metal
electrodes, the cathode and the anode, one at either
end.

When a high voltage is applied between the
electrodes, cathode rays (electrons) are projected in
straight lines from the cathode.
Johann Hittorf - William Crookes
(1880s)
Found that photographic plates
placed near the tube became
unaccountably fogged or flawed by
shadows. Neither found the cause
nor investigated this effect.
Johann Hittorf
(German)
William Crookes
(English)
Ivan Pulyui (Ukrainian)
(1877-1886)
Constructed various designs
of vacuum discharge tube to
investigate their properties.

1886 he found that sealed
photographic plates became
dark when exposed to the
emanations from the tubes.
Early in 1896, just a few weeks after Rntgen published his first X-ray
photograph, Pulyui published high-quality X-ray images in journals in
Paris and London.

Philipp Lenard (German)
(1888)
Conducted experiments to see whether
cathode rays could pass out of the Crookes
tube into the air.

He built a Crookes tube (later called a "Lenard
tube") with a "window" in the end made of
thin aluminum, facing the cathode so the
cathode rays would strike it.

He found that something came through, that
would expose photographic plates and cause
fluorescence.

He measured the penetrating power of these
rays through various materials.

It has been suggested that at least some of
these "Lenard rays" were actually X-rays.
Hermann von Helmholtz
(American)
Formulated mathematical equations
for X-rays.

He postulated a dispersion theory
before Rntgen made his discovery
and announcement.

It was formed on the basis of the
electromagnetic theory of light.

However, he did not work with actual
X-rays.
Wilhelm Rntgen (German)
(1895)
First medical X-ray
by Wilhelm Rontgen
of his wife Anna
Stumbled on X-rays while experimenting with
Lenard and Crookes tubes and began studying
them.

He wrote an initial report "On a new kind of
ray: A preliminary communication" and on
December 28, 1895 submitted it to the
Wrzburg's Physical-Medical Society journal.


This was the first paper written on X-
rays.

Rntgen referred to the radiation as
"X", to indicate that it was an
unknown type of radiation.

The name stuck, although (over
Rntgen's great objections) many of
his colleagues suggested calling them
Rntgen rays.


They are still referred to as such in
many languages, including German,
Danish, Polish, Swedish, Finnish,
Estonian, Russian, Japanese, Dutch,
and Norwegian.

Rntgen received the first Nobel
Prize in Physics for his discovery.
Rntgen realized some invisible rays coming from the tube were passing
through the cardboard to make the screen glow.

He found they could also pass through books and papers on his desk.
Rntgen discovered its medical use when he made a picture of his wife's hand
on a photographic plate formed due to X-rays.
The photograph of his wife's hand was the first photograph of a human body
part using X-rays.

When she saw the picture, she said "I have seen my death.
Wilhelm Trendelenburg
(1916)
As the earlier fluorescent screens
produced limited light, the earlier
radiologists were needed to be in a
dark room where they used to adjust
their vision to the darkness and
increase their light sensitivity.

The radiologist was also exposed to
significant amounts of radiation as
he used to sit behind the screen.

The problem of adjusting vision to
darkness was solved when Wilhelm
Trendelenburg developed red
adaptation goggles in the year 1916.
Westinghouse
(1940s)
The practice of fluoroscopy was revolutionized
when Westinghouse developed X-ray image
intensifier during the late 1940s and also when
close circuit television cameras were introduced
around a decade later.

Image intensifiers could amplify the light
emanated from the fluorescent screen which
made the images visible even in lighted rooms.

This made the red adaptation goggles obsolete.

The camera allowed viewing the images remotely
in a monitor and negated the risk of exposure to
radiation.





The latest developments in image
intensifiers, screen phosphors and flat
panel detectors have enabled
physicians to obtain more high quality
images and have minimized the
chances of the patient being exposed
to harmful radiation.

The modern fluoroscopy machines
employ CSI screens and generate
noise-limited images, making sure that
minimum amount of radiation produce
optimum quality of images.
Komponen Fluoroscopy
Komponen Utama Flouroskopi

X-ray tube dan generator

Image Intensifier

Sistem Monitoring dan Video
X-ray tube dan generator

Adalah tabung pembangkit sinar X untuk di
gunakan dalam flouroskopi.

Spesifikasi:
Sinar X disinari lebih lama
0,5 5,0 mA
Menggunakan High frequency units
Merupakan tabung berkapasitas tinggi (500.000
heat unit)
Image Intensifier

Adalah sistem yang mengolah sehingga
mendapatkan sinyal untuk mendapatkan gambar
atau video yang diinginkan.
Prinsipnya: konversi low intensity full size image ke
high-intensity minified image.

Image Intensifier terdiri dari:
a. Detector
b. PTM ( Phase multiplier tube)

a. Detector
Terbuat dari crystals iodide (CsI) yang
mempunyai sifat memendarkan cahaya
apabila terkena radiasi sinar-X. Absorpsi
dari detektor sebesar 60% dari radiasi
sinar-X.
b. PMT (Photo Multiplier Tube)

Terdiri dari :
Photokatoda
Focusing Electroda
Anode dan Output Phospor

Sistem Monitoring dan Video
Dikarenakan output phospor hanya berdiameter 1
inch (2,54 cm), gambar yang dihasilkan relatif kecil,
karena itu harus diperbesar dan di monitor oleh
sistem tambahan.


sistem penampil gambar ini mampu menampilkan
gambar bergerak secara langsung (Real-Time
Viewing) dan beberapa yang lainnya untuk gambar
diam (Static Image)
Cara Kerja Fluoroscopy
Kegunaan Fluoroscopy
Kegunaan Fluoroscopy
Fluoroscopy digunakan untuk membantu
diagnosis suatu penyakit atau memandu dokter
selama prosedur perawatan.

Barium X-Rays
Bedah orthopedi
Angiografi

Prosedur Fluoroscopy
Sebelum Prosedur Dilakukan
Dokter akan menjelaskan prosedur dan menawarkan
kesempatan untuk menanyakan bagian yang kurang
jelas
Pasien akan diminta untuk menandatangani formulir
yang menyatakan persetujuan Anda.
Dokter akan memberitahu persiapan yang harus
dilakukan sebelum prosedur dilakukan.
Memberitahu dokter apabila Anda pernah mempunyai
reaksi terhadap zat kontras atau alergi terhadap iodine.
Pasien yang sedang/mungkin hamil harus
memberitahu dokter.
Selama Prosedur Dilakukan
Pasien akan diminta untuk memakai baju
medis bila perlu dan/atau melepas perhiasan.
Substansi kontras bisa saja diberikan,
tergantung pada tipe prosedur yang dilakukan.
Anda akan diposisikan pada meja X-Ray bila
perlu.
Scanner X-Ray digunakan untuk memproduksi
citra fluoroskopik.

Contoh Hasil Fluoroscopy
Hasil Scan Fluoroscopy
Lower cervical vertebrae Fracture
Perbaikan acetabulum kanan
Hip Replacement
Hasil Scan Fluoroscopy
Finger Angioma
Hasil Scan Fluoroscopy
Normal
Zenkers Diverticulum
Kelebihan
Benefit
Low Cost dibandingkan dengan MRI
Digunakan untuk menyelidiki pergerakan
suatu organ/sistem tubuh seperti dinamika
alat-alat peredaran darah, misalnya jantung
dan pembuluh darah besar; serta pernapasan
berupa pergerakan diafragma dan aerasi paru-
paru.
Digunakan untuk membantu proses kateter.

Kekurangan
Risk
Risk
Radiation , dari luka bakar akibat radiasi
hingga kanker akibat radiasi.

Annual Radiation Dose
Limits
Agency
Radiation Worker - 50 mSv (NRC, "occupationally" exposed)
General Public - 1 mSv (NRC, member of the public)
General Public - 0.25 mSv (NRC, D&D all pathways)
General Public - 0.10 mSv (EPA, air pathway)
General Public - 0.04 mSv (EPA, drinking-water pathway)
Risk
Harga Alat bisa mencapai Rp. 180.000.000,00
Penggunaannya sulit, memerlukan
keterampilan khusus dan biasanya
operatornya sudah tersertifikasi.

Dosis Melampaui 20 Gy, Necrosis akan muncul
setelah 6-8 bulan akibat angiography dan angioplasty
Risk
Sesi tanya jawab:

Nur wangsa Saputra
Apa kelebihan x-ray terhadap yang lain?

Kelebihanya adalah bisa melihat secara real time
sedang yang lain hanya berupa hasil scan
(gambar).



Ridlo
Kenapa bisa hanya darahnya saja yang
kelihatan, tulangnya tidak kelihatan?
>

Bayu
Kenapa efeknya muncu tidak secara langsung?
(beberapa hari atau beberapa bulan?)

Sel-sel berbeda sensitifitasnya
Untuk yang tidak terlalu sensitif maka efeknya
akan muncul dalam waktu yang lama.