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

IAEA
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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Topics

Example of fluoroscopy systems

Image intensifier component and
parameters
Image intensifier and TV system

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Overview

To become familiar with the components of

the fluoroscopy system (design, technical
parameters that affect the fluoroscopic
image quality and Quality Control).

IAEA 16.1: Optimization of protection in fluoroscopy 4

 IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 16.1: Optimization of protection in

fluoroscopy

Topic 1: Example of fluoroscopy systems

IAEA
International Atomic Energy Agency
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

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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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 IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 16.1: Optimization of protection in

fluoroscopy

Topic 2: Image Intensifier component and

parameters

IAEA
International Atomic Energy Agency
The image intensifier (I.I.)

I.I. Input Screen Electrode E1

Electrode E2
Electrode E3
Electrons
Path

I.I.Output Screen

Photocathode
+

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Image intensifier systems

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Image intensifier component

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 : focusing of electrons onto the output screen
electrodes provide the electronic de-magnification
Output 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 applied tube potential
the diameter () of the input screen
I.I. input screen () of 22 cm Gx = 200
I.I. input screen () of 16 cm Gx = 200 x (16/22)2 = 105
I.I. input screen () of 11 cm Gx = 200 x (11/22)2 = 50

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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)
it can be assessed with a resolution pattern which
contains several sets of patterns at various
frequency
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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 of dust and dirt on the various optical surfaces
reduction in the quality of the vacuum
aging process (deterioration of phosphor screen)
Sources of noise are:
X Ray quantum mottle
photon-conversion processes, film granularity, film processing

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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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 IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology

Part 16.1: Optimization of protection in

fluoroscopy

Topic 3: Image Intensifier and TV system

IAEA
International Atomic Energy Agency
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 film
35 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

PM REFERENCE CONTROLLER
FILM
kV
VIDICON

GENERAL SCHEME OF FLUOROSCOPY

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 kV
X Ray TUBE

CINE MODE

I2 I3
CONTROLLER

I1

PM C1 C2 Ref.
FILM
VIDICON

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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)
higher quantum noise level
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 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

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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
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
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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 SYNCHRO
DIGITIZED SIGNAL 12 s
LIGHT SAMPLING
INTENSITY
SINGLE LINE TIME
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Digital radiography principle

ANALOGUE
SIGNAL

I
ADC Memory t

DIGITAL
Iris SIGNAL

Clock

t
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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