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IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment L04. Educational objectives. How is fluoroscopy equipment designed?

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Anatomy of fluoroscopy ct fluoroscopy equipment l04

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

Anatomy of Fluoroscopy & CT Fluoroscopy EquipmentL04


Educational objectives

Educational objectives

  • How is fluoroscopy equipment designed?

  • What are the different factors that influence the X ray output from a fluoroscopic system?

  • What are the new developments in fluoroscopy equipment?

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Anatomy of fluoroscopy ct fluoroscopy equipment l04

Early (Screen Only) Fluoroscopy

Fluorescent screen with leaded glass

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Modern image intensifier based fluoroscopy system

Modern Image Intensifier based fluoroscopy system

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Components of c arm equipment

Components of C-arm equipment

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Anatomy of fluoroscopy ct fluoroscopy equipment l04

Bi-plane C-arm setup

From: R Kruger et al, Spine 2003

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


A modern bi plane c arm with flat panel detectors

A Modern Bi-Plane C-Arm with Flat Panel Detectors

Flat panel

Image Receptors

X ray Tubes

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Anatomy of fluoroscopy ct fluoroscopy equipment l04

Multi-purpose C-arm Fluoroscopy System

Image Intensifier

X ray tube

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Over couch vs under couch x ray tubes

Over-couch vs Under-couch X ray Tubes

Image Intensifier

X ray Tube fixed under table

X ray Tube fixed over table

Image Intensifier

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Over couch vs under couch x ray tubes1

Over-couch vs Under-couch X ray Tubes

  • Under-Table X ray tube system subject the operator to much less scattered radiation than do over-table X ray tube systems.

  • It is therefore preferable to have the X ray tube mounted below the table when purchasing fixed configuration systems.

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


The image intensifier ii

The Image Intensifier (II)

Its function is to

  • Convert X rays into visible light

  • Increase the image brightness so it is visible to the camera and recording devices

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Automatic brightness control abc

Automatic Brightness Control (ABC)

  • Adjusts X ray intensity to produce image of predefined brightness

  • Adjusts kV and mA in various ways to achieve predefined image brightness.

  • Normally adjusts kV with associated adjustment in mA

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Theory of operation abc

Theory of Operation – ABC

Monitor

Camera

Iris/Diaphragm

Optics

Image

Image Intensifier

Brightness

Feedback

Grid

Table

Reference Brightness

Collimator

Filter

Automatic

Generator

X ray Tube

K

kV,mA

Brightness

Control

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Automatic exposure control and patient thickness

Automatic Exposure Control and Patient Thickness

Pulse Width

Focal Spot Size

Filtration

mA

kV

Very

Large

Very

Small

Small

Large

Medium

Patient size


Imaging modes fluoroscopy versus acquisition magnification dose level

Imaging modes Fluoroscopy versus Acquisition,Magnification, Dose level


Anatomy of fluoroscopy ct fluoroscopy equipment l04

Magnification

Synonyms:

MAG

Zoom

Field View (FOV)

Image Intensifier field size

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Anatomy of fluoroscopy ct fluoroscopy equipment l04

6”

9”

Magnification

Smaller Image Intensifier Mode (“MAG”) has better resolution

0.15 mm / pixel vs. 0.23 mm/pixel

… but higher exposure to patient and staff

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Radiation output and mag modes

Radiation Output and Mag Modes

  • Exposure Rate change = (old FOV)2/(new FOV)2

  • Example: go from 40 cm to 30 cm

  • 402/302 = 1.77

  • So the smaller FOV will need 1.77x more radiation for the same image brightness

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Anatomy of fluoroscopy ct fluoroscopy equipment l04

ABC increases patient dose for increased MAG

Normal, 40 cm FOV,1 dose unit

MAG 1, 33 cm FOV,1.46 dose units

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment

MAG 3, 17 cm FOV,5.5 dose units

MAG 2, 23 cm FOV,3.0 dose units


Anatomy of fluoroscopy ct fluoroscopy equipment l04

High Fluoro,

MAG 2

Low Fluoro,

No MAG

> 10 fold more exposure rate

13 cm

17 cm

23 cm

(+) mode increases dose by 50% compared to normal.(-) mode decreases dose by 50% compared to normal.

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Anatomy of fluoroscopy ct fluoroscopy equipment l04

Fluoroscopy vs Image Acquisition

Can you tell ……….

Which image is FLUOROSCOPY, which one is ACQUISITION?

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Anatomy of fluoroscopy ct fluoroscopy equipment l04

Fluoroscopy

Continuous display of images, normally without recording, except last image hold (LIH)

Image Acquisition

Discrete or multiple images recorded in sequence.

Commonly known as runs or cine runs

> 10 fold more exposure rate

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Anatomy of fluoroscopy ct fluoroscopy equipment l04

Better image quality with higher radiation dose reaching the image receptor.

Tradeoff: higher patient and staff dose!!

Image

Quality

Radiation

Dose

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Anatomy of fluoroscopy ct fluoroscopy equipment l04

ALARA

No known safe limit of magnitude of radiation exposure

As Low As Reasonably Achievable

Physicians

Patients

Professional

staff

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Pulsed fluoroscopy

Pulsed Fluoroscopy


Anatomy of fluoroscopy ct fluoroscopy equipment l04

Pulsed fluoroscopy

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Effect of filtration

Effect of filtration

  • What is beam filtration?

    • Absorber placed between source and object

    • Will preferentially absorb the lower energy photons

    • Patient skin dose reduction

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Effect of filtration1

Effect of filtration

For equal kVp

Increased mean

beam energy

Increased

Mean

Energy

With increased filter and increased mA

Intensity

Low

Filtration

Spectrum

kVp

Photon energy, keV

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Effect of filtration2

Effect of filtration

  • Additional Cu filters can reduce the skin dose by more than 70%.

  • Some systems offer variable extra filtration (0.2 mm - 0.9 mm) that is automatically set according to patient weight and angulation of the C-arm.

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Anatomy of fluoroscopy ct fluoroscopy equipment l04

Other important elements

Collimator

Dose Area Product (DAP)

meter

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Collimator

Collimator

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Collimator1

Collimator

Collimation confines the X ray beam to an area of the user’s choice.

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Collimator2

Collimator

Why is narrowing the field-of-view beneficial?

  • Reduces exposure to patient by reducing volume of tissue at risk

  • Reduces scatter radiation at image receptor to improve image contrast

  • Reduces scatter radiation to in-room personnel

  • Reduces potential overlap of fields when beam is reoriented

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Dose rates and aging equipment

Dose Rates and Aging Equipment

  • Image Intensifier efficiency at converting X rays to light reduces over time. Thus the image becomes dimmer.

  • Via the ABC, Image Intensifier input doses rates go up to compensate. (Patient and staff doses also increase.)

  • A service engineer can open optical iris of TV camera to compensate, but at some stage no further adjustment available & image intensifier replacement needs to be considered.

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


C arm control panel

C-arm Control Panel

kVp

,

mA

display “Radiation on” warning

Tube temperature alarm

Image transfer controls Procedure timer

Fluoro dose mode

Low / high

On Off

Manual fluoro

Automatic fluoro

Pulsed fluoro

Image acquisition/

Manual controls

MAG/Zoom/

II field size

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


New developments

New developments

  • Flat panel detectors

  • CT fluoroscopy

  • Mobile CT in operation theatre

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Flat panel detector

Flat panel detector

Flat panel detector instead of image intensifier

For the user, dose level, MAG, filters and other parameters remain more or less the same

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Flat panel detector bi plane system

Flat panel detector: bi-plane system

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Ct fluoroscopy real time ct

CT Fluoroscopy – real-time CT

  • Staff enters CT room during acquisition

Biopsy mediastinal mass

Needle holder

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Ct fluoroscopy real time ct1

CT Fluoroscopy – real-time CT

Applications

Core biopsies, precise needle placement, fluid collection aspirations, drainage, local drug injection, RF ablation, lumbar nerve root blocks, vertebroplasty, arthrography, etc

Users

Radiologist, pneumologist, orthopedic surgeon, anesthetist

Patient skin dose rates typical > 10 times higher than in C-arm fluoroscopy

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Ct fluoroscopy real time ct2

CT Fluoroscopy – real-time CT

Typical tube current settings in CTF

10 mA paediatrics, 10-40 mA chest, 40-50 mA abdominal

Staff protection

Standoff needle device to increase distance to primary beam

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Ct in the operating theatre

CT in the operating theatre

  • CT based surgical navigation – mobile system

  • Staff leaves room during acquisition

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Ct in the operating theatre1

CT in the operating theatre

  • Also works in 2D conventional fluoroscopy mode

3D mode delivers radiation dose to patients that is comparable to that of a 64 slice CT scanner.

2D mode delivers radiation dose to patients and staff comparable to that of a conventional C-arm system

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


Thank you

Thank you

IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy

L04. Anatomy of Fluoroscopy & CT Fluoroscopy Equipment


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