FLUOROSCOPY

Imaging system used for monitoring Catheter

based procedures.
Fluoroscopy overview
• The principal feature of the imaging chain that
distinguishes Fluoroscopy from radiography is the ability
to produce real-time x-ray images with high frame rates
and a low-dose per image. (5 configurations possible)
• gastrointestinal/genitourinary (GI/GU) systems (with the x-ray tube
under the patient table);
• remote fluoroscopy (over-table x-ray tube);
• interventional vascular (vascular surgery, radiology);
• cardiology and interventional electrophysiology, and
• mobile C-arm confgurations (surgery, pain medicine).
• All confgurations have the same basic components.
Fluoroscopy Imaging Chain
• The basic product of the
Fluoroscopy system is a
projection image.
• Images are acquired at
movie frame rates, so at
30 fps a five minute
session would mean
9000 images.
• So the system should be
capable of obtaining
quality images at low
‘Doses’.
Sensitive Detectors
• Image Intensifiers.
• Flat Panel Detectors.
• Flat panel detectors requires way less radiation than standard
radiography detectors for producing acceptable quality images. For
instance fluoroscopy requires 9-17 nGy incident upon the detector
per image while a X-ray CT or CAT scanner detector requires 5-9
microGy.
Image Intensifier based Fluoroscopy
Image Intensifier Image Intensifier

• (a) a vacuum housing to keep

air out and allow unimpeded
electron flow,
• (b) an input layer that converts
the absorbed incident x-rays
into light, which in turn releases
electrons,
• (c) an electron optics system
that accelerates and focuses
the electrons emitted by the
input layer onto the output
layer, and
• (d) an output phosphor that
converts the accelerated
electrons
Image Intensifier..
• Incident x-rays pass through
the antiscatter grid (not shown),
and must also pass through the
vacuum support window (1 mm
Al) and the support of the input
phosphor (0.5 mm Al).
• X-rays are absorbed by the CsI
input phosphor, producing green
light that is channeled within the
long CsI needles to the
antimony-trisulfide
photocathode, which then ejects
electrons into the vacuum space
of the II.
• Scanning electron micrographs
illustrate the crystalline needle–
like structure of CsI.
Image Intensifier….
CsI
• 400 micron tall and 5 micron wide columnar structures on
top of a substrate, channels light with minimal spreading
as compared to other phosphors.
• For a 60-keV x-ray photon, 3000 light photons are
emitted.
• Photocathode is a thin layer of antimony and alkali metals
that emits electrons when struck by visible light.
• 10-20% conversion efficiency, 400 electrons are released
per 60keV X-ray photon captured in the CsI.
Image Intensifier…
Electron Optics
• The electrons are accelerated by a large electric fielld
created by a high voltage- between the anode and the
cathode.
• Focusing the electrons is accomplished by the several
electrodes in the electron optics chain.
• The kinetic energy of each electron is dramatically
increased by acceleration due to the voltage difference
between the cathode and anode, resulting in electronic
gain.
• The spatial pattern of elec-trons released at the
photocathode is maintained at the output phosphor, albeit
minified
Distortions due to electron optics
Output Phosphor

• The output phosphor is made of zinc

cadmium sulfide doped with silver
(ZnCdS: Ag), which has a green (530 nm)
emission spectrum.
• The ZnCdS phosphor particles are very
small (1 to 2 micron), and the output
phosphor is quite thin (4 to 8 micron), to
preserve high spatial resolution.
• The anode is a very thin (0.2 mm) coating
of aluminum on the vacuum side of the
output phosphor, which is electri-cally
conductive to carry away the electrons
once they deposit their kinetic energy in
the phosphor.
• Each electron causes the emission
approximately 1,000 light photons from
the output phosphor.
 The ‘Intensification’
• A 15-35 cm diameter input image is focused to about 2.5cm circle
• To preserve a resolution of 5 line pairs/mm at the input plane, the output
phosphor must deliver a resolution of about 70 lp/mm or better.
• The reduction in image diameter also leads to light intensity amplification,
since, for example, the electrons produced on the 410 cm2 area of the
23-cm-diameter input phosphor are concentrated onto the 5-cm2 output
phosphor.
• By analogy, a magnifying glass collects light over its lens surface area
and can focus it onto a small spot, and in the process, the light intensity
is amplified enough to start a fire using only sunlight.
• The so-called minification gain of an II is simply the ratio of the area of
the input phosphor to that of the output phosphor.
• The ratio of areas is equal to the square of the ratio of diameters, so a
23-cm-diameter II (with a 2.5-cm-diameter output phosphor) has a
minification gain of (22.8/2.55)^2 =81, and in 17-cm mode it is 49.
Optical coupling to video camera
• The lenses used in fluoroscopy systems focus light
emitted at the output phosphor onto the focal plane of the
video camera.
• The lens assembly includes an adjustable aperture,
basically a small hole positioned between individual
lenses. Adjusting the size of the hole changes how much
light gets through the lens system.
• By lowering the gain of the II and associated optics by
increasing the f-number, a higher x-ray exposure rate will
result, producing lower noise images and higher patient
dose. Increasing the gain reduces the x-ray exposure rate
and lowers the dose, but reduces image quality.
Brightness Gain
• The brightness gain is the product of the electronic and
minification gains of the II. The electronic gain of an II is
roughly about 50, and the minification gain is variable
depending on the electronic magnifcation
• . For a 30-cm (12-inch) diameter II, the minification gain
is 144, but in 23-cm (9-inch) mode it is 81, and in 17-cm
(7-inch) mode it is 49.
• The overall brightness gain, therefore, ranges from about
2,500 to 7,000. As the effective diameter (FOV) of the
input phosphor decreases (increasing magnification), the
brightness gain decreases.
Automatic Exposure rate control
• The purpose of the automatic exposure rate control
(AERC) circuit is to keep the signal-to-noise ratio (SNR) of
the image constant when possible.
• The ABC or AERC sensor constantly monitors the
intensity of the X-ray photons and strives to keep the
photon fluence level at the detector, constant.
• Whenever X-ray fluence is lowered a signal is sent to the
X-ray generator to increase the incident fluence level. This
can be done by changing the mA and kV.
• Some AERC systems manipulate the lens aperture once
the regulatory limit is reached.
Fluoroscopy modes of operation
• Continuous fluoroscopy
• 33 ms integration time
• Variable frame rate pulsed fluoroscopy
• 3-8ms integration time
• High frame rates not necessary all the time, can be used in fast
moving anatomy ie pulsative blood vessels.
Field of View and Magnification Modes
• IIs are available in 23,30,35 and 40cm field of view.
• For GI and GU large FOV is required
• 23cm is adequate for cardiac imaging
• Magnification modes are obtained by changing the
voltages applied to the electrodes in II, resulting in
electron focusing from a smaller area of the II input
screen.
• When the magnification mode is engaged the X-ray
collimator automatically adjusts to match the X-ray beam
dimensions to the smaller field of view.
Flat panel detector based fluoroscopy
systems
• Comprised of thin film transistors arrays of individual
detector elements, each element of the array ie pixel has
its own circuitry to record the X-ray photon intensity
incident on that pixel.
• Each pixel has a capacitor for storing the charge induced
(charge scales linearly with the incident energy of the X-
rays) and a transistor which acts as a switch
• Direct and Indirect X-ray detection.
• Direct detection- X-ray induced charge in Selenium is directly
detected.
• Indirect detection- X-ray is converted to light and then detected.
Photodiodes convert light to charge, which is then stored in a
capacitor attached to each pixel element.
Resolution
• The limit is set by the size of the detector element.
• For a system with 30cm fOV and 1024^2 imaging matrix,
the nyquist sampling frequency is 1.7 lp/mm
corresponding to a detector element size of 0.29mm.
Fluoroscopy Suites
• Genitourinary
• Remote fluoroscopy rooms
• Peripheral angiography suites
• Cardiology catheterization suites
• Cardiology electrophysiology laboratory
• Biplane aniographic systems
• Mobile fluoroscopy C-arms