fluoroscopy

UTHARA MENON
II MDS

CONTENTS

HISTORY
INTRODUCTION
DENTAL FLUOROSCOPIC IMAGING SYSTEM
DREAMRAY 60F
CLINICAL APPLICATION
DISADVANTAGES

HISTORY
The beginning of fluoroscopy can be traced back to 8 Nov. 1895
when Wilhelm Roentgen noticed a barium platinocyanide screen
fluorescing as a result of being exposed to what he would later call
x-rays.
The fluoroscopic image obtained in this way was rather faint.

Thomas Edison quickly discovered that calcium tungstate screens

produced brighter images and is credited with designing and
producing the first commercially available fluoroscope.

Eisenberg R L. Radiology. An illustrated history. 1895 Centennial 1995: Mosby Ye

 The first fluoroscope for dental use was described by William

Herbert Rollins in 1896.
Due to the limited light produced from the fluorescent screens,
early radiologists were required to sit in a darkened room in
which the procedure was to be performed, getting their eyes
accustomed to the dark and thereby increasing their sensitivity to
the light.
The placement of the radiologist behind the screen resulted in
significant radiation doses to the radiologist

Eisenberg R L. Radiology. An illustrated history. 1895 Centennial 1995: Mosby Ye

 Red adaptation goggles were developed by Wilhelm

Trendelenburg in 1916 to address the problem of dark adaptation
of the eyes,

The resulting red light from the goggles' filtration correctly

sensitized the physician's eyes prior to the procedure while still
allowing him to receive enough light to function normally.

Eisenberg R L. Radiology. An illustrated history. 1895 Centennial 1995: Mosby Ye

 The invention of X-ray image intensifiers in the 1950s allowed the

image on the screen to be visible under normal lighting
conditions, as well as providing the option of recording the images
with a conventional camera.
Subsequent improvements included the coupling of, at first, video
cameras and, later, video CCD cameras to permit recording of
moving images and electronic storage of still images.

Eisenberg R L. Radiology. An illustrated history. 1895 Centennial 1995: Mosby Ye

introduction
Fluoroscopy was invented by Thomas Edison in 1896.
The worlds first dental X-ray fluoroscopic equipment was
developed in Korea (DreamRay Co., Ltd.)
FLUOROSCOPY-Specifically used for diagnostic evaluation
&interventional examinations of hollow organs.

Radiation Protection Dosimetry (2010), Vol. 140, No.

 The dental fluoroscope was not used in dentistry routinely,

because of the high level of radiation emitted by the early design.

In 1953, image intensification and low mA settings were

introduced.

Since then, radiation exposure to patients has been considerably

reduced, and many applications of dental fluoroscopy have been
proposed.

Radiation Protection Dosimetry (2010), Vol. 140, No.

Dental fluoroscopic imaging

system

A flat panel detector (intra or extra oral)comprised by

a gamma rays or x ray convertor,
a plate,
a collector.
a processing unit and
a transmitter suitable for 2D intraoral and extraoral.
And 3D extraoral dental fluoroscopy.

US PATENT APPLICATION

a gamma rays or x ray convertor

a plate

a collector

a processing unit and a transmitter

A host

 X ray convertor converts

EMITTER

LOW DOSE GAMMA RAYS

OR

X RAYS BEAM

ELECTRIC SIGNALS OR A LIGHT

IMAGE

The plate transmits the electric signals or light image to a collector

which amplifies it and sends to a processing unit and then to
transmitter designed to transfer digital images sequentially to a host
computer and software which can acquire, process, transform,

record, freeze and enhance 2D and 3 D images of video frame rate

US PATENT APPLICATION

 2D images obtained through C arm or U arm configuration

3D images obtained through O arm configurataion

US PATENT APPLICATION

DreamRay 60F
The dental X-ray fluoroscopic equipment,DreamRay 60F, is based
on the mechanism of the C arm that is used in an operating room.
The X-ray tube and the image-detecting part are in the shape of
the U-arm; the tube emits a cone beam of X rays to minimise the
scattered rays, and the image detector with a diameter of 43 mm
enables three teeth and neural canals to be monitored
simultaneously.

Radiation Protection Dosimetry (2010), Vol. 140, N

Overview of the dental mini C-arm (DreamRay 60F)

(A). The dental mini C-arm can take images in a range of
about 25 to 25 at the coronal plane
(B). Basically, the C-arm, which consists of an image intensifier and
X-ray generator, is tilted about 30 to the transverse plane, and can
capture images in a range of 25 at the axial (transverse) plane
(C). The patient can turn his or her head about 65 to the sagittal
plane in either direction (C)
Journal of Cranio-Maxillofacial Surgery Volume 40, Issue 7, October 2012,

Clinical application
The screen shows real-time images of the teeth, bones and nerves,
difficult cases and sudden emergencies can be coped with easily.
It is useful for delicate and complicated operations, such as
implantation.
The distance between the neural canals and screw of the drill and
between the teeth and maxillary sinus can be monitored during
the procedure, and the implant can be implanted more deeply and
tightly than planned and can withstand longer use.

Radiation Protection Dosimetry (2010), Vol. 140, No. 4, pp. 362368

 Removal of broken instruments in the oral and maxillofacial area,

the newly developed dental mini C-arm was useful in finding
broken instruments in soft tissue and in paranasal sinus ,because it
gives real time in situ information.

The position of the broken instrument can be changed due to

traction of the soft tissue or swelling.

The dental mini C-arm was less helpful in finding broken

instruments in soft tissues compared to hard tissues,as the position
of instruments did not change
Journal of Cranio-Maxillofacial Surgery Volume 40, Issue 7, October 2012,

 A broken dental needle was located in the left pterygomandibular

space.

 Broken needle (in the red circle) in preoperative panoramic view

(A) and
posterio-anterior skull view (B).
Fluoroscopic image of the broken needle (in the red circle) by
the dental mini C-arm(C).
Orientation of superiorinferior and anteriorposterior position
of the broken needle using the blunt end of haemostat (1:
channel retractor, 2: haemostat, 3: broken needle) (D).
Detecting of the broken needle buried in the medial pterygoid
muscle using the sharp end of periosteal elevator after dissection
guided by fluoroscopic image (1: Seldin retractor, 2: periosteal
elevator, 3: broken needle) (E)
and its exposure to oral cavity (arrow dictating a broken dental
needle) (F).

Journal of Cranio-Maxillofacial Surgery Volume 40, Issue 7, October 2012,

 Complete removal of the broken needle was confirmed by

fluoroscopic image (A)
and orthopanogram (1: Penrose drain) (B).
Removed broken dental needle (C).

Journal of Cranio-Maxillofacial Surgery Volume 40, Issue 7, October 2012,

Implant fixture was placed in the left maxillary sinus. Panoramic

view (A),
Waters view (B),
and fluoroscopic view (C).
Implant fixture was removed by suction tip through the implant
fixture installation site (1: suction tip) (D).
Removed implant fixture (E)
Journal of Cranio-Maxillofacial Surgery Volume 40, Issue 7, October 2012,

DISADVANTAGES
More patients and medical workers are exposed to radiation with
the increasing frequency of fluoroscopy use.
The two major risks associated with fluoroscopy are
- radiation-induced injuries to the skin and underlying tissues
(burns), and
- the small possibility of developing a radiation-induced cancer
some time later in life.
Soft tissue resolution is poor

Radiation Protection Dosimetry (2010), Vol. 140, No