Fluoroscopy
- Description
- Uses
- Risks/Benefits
- Information for Patients
- Information for Professionals
- Laws, Regulations & Performance Standards
- Industry Guidance
- Other Resources
Description
Fluoroscopy is a type of medical imaging that shows a continuous x-ray image on a monitor, much like an x-ray movie. It is used to diagnose or treat patients by displaying the movement of a body part or of an instrument or dye (contrast agent) through the body.
During a fluoroscopy procedure, an x-ray beam is passed through the body. The image is transmitted to a monitor so that the body part and its motion can be seen in detail.
Uses
Fluoroscopy is used in many types of examinations and procedures. Some examples include
- Barium x-rays and enemas (to view movement through the GI tract)
- Catheter insertion (to direct the placement of a catheter during angioplasty or angiography)
- Blood flow studies (to visualize blood flow to organs)
- Orthopedic surgery (to view fractures and fracture treatments)
Risks/Benefits
Fluoroscopy is a type of x-ray procedure, and it carries the same types of risks as other x-ray procedures. The radiation dose the patient receives varies depending on the individual procedure.
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.
When an individual has a medical need, the benefit of fluoroscopy far exceeds the small cancer risk associated with the procedure. Even when fluoroscopy is medically necessary, it should use the lowest possible exposure for the shortest possible time.
Fluoroscopy
Intro to EQUIPMENT
RT 244
FALL 2008
Week 1
Wed- CONTINUED
Basic Componets of “old” Fluoroscopy “Imaging Chain”
Conventional I I system
IMAGE INTENSIFIER
The anode of the II
Anode and Output Screen
lAnode
lPositively charged
l25 kVp
lHole in center allows electrons to pass through to output screen
lOUTPUT SCREEN
lUsually 1 inch in diameter
lZinc cadnium sulfide coating
lChanges electrons back to LIGHT
Image Intensifier
PROPERTIES
Image Quality
Contrast
Resolution
Distortion
Quantum mottle
Contrast
lControlled by amplitude of video signal
lAffected by:
lScattered ionizing radiation
lPenumbral light scatter
Veiling glare
lScatter in the form of x-rays, light & electrons can
lreduce contrast of an image intensifier tube.
Resolution
lVideo viewing
lLimited by 525 line raster pattern of monitor
lNewer digital monitors 1024 - better resolution
lMORE ON THIS LATER IN THE LECTURE
Image distortion
Shape Distortion
lGeometric problems in shape of input screen
lConcave shape helps reduce shape distortion, but does not remove it all
lVignetting or pin cushion effect
lVignetting
FALL-OFF OF BRIGHTNESS AT PERIPHERY (EDGES) OF THE IMAGE
VIGNETTING…….
lDarkness on edges (falloff of brightness)
Size Distortion
lAffected by same parameters as static radiography
lPrimarily OID
lCan be combated by bringing image intensifier as close to patient as possible
ABC
Basic Componets of “old” Fluoroscopy “Imaging Chain”
Brightness Control
lAutomatic brightness stabilization
lAutomatic adjustments made to exposure factors by equipment
lAutomatic gain control
lAmplifies video signal rather than adjusting exposure factors
BRIGHTNESS CONTROL
lABC ABS AEC ADC
lMAINTAINS THE BRIGHTNESS OF THE IMAGE – BY AUTOMATICALLY ADJUSTING THE EXPSOURE FACTORS (KVP &/OR MAS) FOR THICKER PARTS
lSLOW RESPONSE TIME - IMAGE LAG
ABC
lAutomatic brightness control allows Radiologist to select brightness level on screen by ↑ kVp or ↑ mAs
lAutomatic dose control
lLocated just beyond the Output Phosphor
lWill adjust according to pt thickness
Automatic Brightness Control
lMonitoring Image Brightness
lPhotocell viewing (portion of) output phosphor
lTV signal (voltage proportional to brightness)
lBrightness Control:
lkVp variable
lmA variable/kV override
lkV+mA variable
lPulse width variable (cine and pulsed fluoro)
Quantum Mottle
lBlotchy, grainy appearance
lCaused by too little exposure
lMost commonly remedied by increasing Ma
lControlled by the ABC
lAffected by too little technique
l size of patient
l distance of II to patient
l size of collimation
Fluoroscopic Noise
(Quantum Mottle)
Fluoroscopic image noise can only be reduced by using more x-ray photons to produce image. Accomplished in 3 ways:
lIncrease radiation dose (bad for patient dose)
lFrame-averaging:
lcreates image using a longer effective time
lCan cause image lag (but modern methods good)
lImprove Absorption Efficiency of the input phosphor
KEEP I.I. CLOSE TO PATIENT
reduces beam on time
Units of measurement
lINPUT PHOSPHOR – IS MEASURED IN _________________________________
lOUTPUT PHOSPHOR IS MEASURED IN
l______________________________
Units of measurement
lINPUT PHOSPHOR – IS MEASURED IN
Milliroentgens mR
lOUTPUT PHOSPHOR IS MEASURED IN
CANDELAS (LIGHT)
VIEWBOXES ARE MEASURED IN: lamberts (light)
Fluoroscopic Imaging
Coupling I.I. to TV Monitor
l2 Methods:
lFiber optics directly to T.V. camera.
lLens system which utilizes auxiliary imaging devices.
Directly to T.V.
lOnly cassettes can be used.
Beam splitting mirror
Basic Componets of “old” Fluoroscopy “Imaging Chain”
Beam splitting mirror
lOften a beam splitting mirror is interposed between the two lenses.
lThe purpose of this mirror is to reflect part of the light produced by the image intensifier onto a 100 mm camera or cine camera.
lTypically, the mirror will reflect 90% of the incident light to other RECORDING DEVICES
land transmit 10% onto the television camera*.
l*TV MONITOR is the weakest link (low resolution)
Viewing Fluoroscopic Images
Lenses / Mirrors
lUsed to direct image to recording devices
lSeveral mirrors in a series and angled - the last mirror is outside the II for the operator to view
lImage decreases as it is projected from 1 mirror to the next
lOnly 1 person can view image
RECORDING THE IMAGE
STATIC IMAGES
DYNAMIC IMAGES
Basic Componets of “old” Fluoroscopy “Imaging Chain”
Recording the Fluoroscopic Image
lSTATIC IMAGES
lCassettes
l105 mm chip film = 12 frames per second
lDigital fluoroscopy
lDYNAMIC VIEWING:
lCine film
lVideotape
Recording Fluoroscopic Images
IMAGE RECORDING
lOLD II - ONLY FIBER OPTICS –NO LENS SPLITTER TO OTHER RECORDING DEVICES
lONLY RECORED IMAGE ON SPOT CASSETTES (9X9 ONLY)
lNEWER - TAKES CASSETTES or uses /105 PHOTOSPOT / VIDEO/ CINE
lNEWEST = USES DIGITAL !!!!!!!!!
l(but the tests* still have all of it!)
Basic Componets of “old” Fluoroscopy “Imaging Chain”
Fluoroscopy mA
lLow, continuous exposures .05 – 5 ma
(usually ave 1 – 2 ma)
lRadiographic Exposure
for cassette spot films
lmA increased to 100 – 200 mA
RECORDING IMAGES
lOLD (Smaller) II with fiber optic
lONLY RECORDING WAS CASSETTE
lCASSETTE “SPOT” IMAGES
lTAKEN DURING FLUORO PROCEDURE
lVERY OLD 9X9 inch cassettes
lLater could take up to 14 x 14 inches
Cassettes
lStandard size - 9” x 9” (old)
lNOW CAN TAKE UP TO 14X14
lStored in lead-lined compartment until ready for exposure
lWhen exposure is made, mA is raised to radiographic level
lMultiple image formats
Image recording
Basic Componets of “old” Fluoroscopy “Imaging Chain”
70 & 105 PHOTOSPOT (CAMERA)
lPhoto spot camera will take the image right off the output phosphor
lThis requires less patient dose
l70 & 105 mm roll film
CASSETTE SPOT FILMING
vs PHOTOSPOT FILMING
lFirst type of recording used
l9x9 cassettes then later up to 14x 14
l9 on 1, 4 on 1, 2 on 1
lDelay while filming (anatomy still moving)
lRadiographic mA - must boost up to
l100 – 200 mA for filming
lAnd moving cassettes around inside tower
lHigher patient dose
lReplaced by Photospot (f/sec) filming
CASSETTE SPOT FILMING
vs PHOTOSPOT FILMING
lPhotospot (f/sec) filming –
lSet at control panel from 1 f/sec – 12 f/sec
lUsed for rapid sequence:
l
lVoiding Cystourethrograms (Peds)
lLower patient dose
Recording the Fluoroscopic Image
lDynamic systems
lCine film systems
lVideotape recording
lStatic spot filming systems
TV camera and video signal
& Recording the image
Cine Film Systems
lMovie camera intercepts image
l16 mm and 35 mm formats
lRecord series of static exposures at high speed
l30 – 60 frames per second
lOffer increased resolution
lAt the cost of increased patient dose
Cinefluorgraphy aka CINE
l35 or 16 mm roll film (movie film)
l35 mm ↑ patient dose / 16 mm –
lhigher quality images produced
l30 f/sec in US – (60 frames / sec)
lTHIS MODALITY = HIGHEST PATIENT DOSE (10X greater than fluoro)
l(VS SINGLE EX DOSE IS ↓)
Cine
lCinefluorography is used most often in cardiology and neuroradiology.
lThe procedure uses a movie camera to record the image from the image intensifier.
lThese units cause the greatest patient doses of all diagnostic radiographic procedures, although they provide very high image quality.
lThe high patient dose results from the length of the procedure and relatively high inherent dose rate.
lFor this reason special care must be taken to ensure that patients are exposed at minimum acceptable levels.
lPatient exposure can be minimized in a number of ways. The most obvious means of limiting exposure is to limit the time the beam is on.
l CINE - 2mR per frame (60f/sec)
l400 mr per “look”
More on Cine
lSynchronization
lFraming frequency
lF-number of the optical system
lFraming and patient dose
Synchronization
lCamera shutters and x-ray pulsed fluoro happen at the same time
lOnly exposes pt when shutter is open to record image
lPatient radiation dose ↑ as #/f/sec ↑
l(filming a TV show – pattern seen)
F-number of the optical system
lSpeed of any given camera system
lThe amount of light made available to the lens
Framing and patient dose
syll = Pg 31
lThe use of the available film area to control the image as seen from the output phosphor.
lUnderframing
l Exact Framing, (58 % lost film surface)
lOverframing,(part of image is lost)
lTotal overframing
OVERFRAMING vs Exact Framing
Framing frequency
lNumber of frames per second
lCine – division of 60 (7.5, 15,30,90,120)
lOrgan if interest determines f/s rate
lPatient exposu
More on Safety later….
RECORDING DEVICES
RESOLUTION P 542 (3rd ed)
OPTICAL MIRROR – BEST BUT NOT PERMANENT RECORDING MEDIUM
lSPOT FILM CASSETTES 6LP/MM
lPHOTO SPOT 105 / 70
lCINE 35 MM / 16 MM
lDIGITAL (?) (VS FILM)
lVIDEO – VIEWING REALTIME
lVIDEO TAPE - PLAYBACK
Line pair gauges
Line pair gauges
Video disc
lThis technique is referred to as electronic radiography.
lFluoroscopic radiation continues only long enough to build up a useful image on the display monitor.
lThe image is stored as a single television frame on the video disc recorder.
lThere is about a 95% reduction in patient dose.
Video tape
lUtilizes VHS or high-resolution tapes.
lPatient’s exposure to radiation is not increased.
lUsed for barium swallows.
Image Quality - Review
lTerms that are necessary to know:
lVignetting is the loss of brightness at the periphery of the II due to the concave surface
lPincushion effect is the drop off at the edges of the II due to the curved surface
lQuantum mottle is the grainy appearance on the image due to statistical fluctuations
lThe center of the II will always have the best resolution.
lLag is the blurry image from moving the II too fast
OVERFRAMING vs Exact Framing
Monitoring
VIDEO/CAMERA TUBE
lPLUMICON, VIDICON, ORTHOCON
lVIDICON MOST COMMOM
lORTHOCON – VERY $$$$
lPLUMICON – BETTER RESOLUTION
lTRANSFERS IMAGE FROM OUTPUT PHOSPHOR TO TV MONITOR
lCONNECTED BY FIBER OPTICS
VIDEO/CAMERA TUBE
PLUMICON, VIDICON, ORTHOCON, CCD’s
lTRANSFERS IMAGE FROM OUTPUT PHOSPHOR TO TV MONITOR
lCONNECTED BY FIBER OPTICS or Optical Lens
lVIDICON- MOST COMMOM
lPLUMICON – BETTER RESOLUTION
lCCD – Charged Coupling Devices
lORTHOCON – VERY $$$$
VIDEO/CAMERA TUBE
lVIDICON MOST COMMOM
l– good resolution with moderate lag – ok for organs
lUses ANTIMONY TRISULFATE
lPLUMICON (a modification of Vidicon)
l– BETTER RESOLUTION / (↓ dose)
lBetter for moving part like the heart –faster response time
lHigh performance, lag may improve, but ↑quantum mottle
lUses LEAD OZIDE
lORTHOCON – VERY $$$$ - Larger (Not used) BEST RESOLUTION WITH NO LAG
lFunctions as both II and pick up tube
lCCD – smaller & longer life, very little image lag
Type of TV camera
FVIDICON TV camera
Fimprovement of contrast
Fimprovement of signal to noise ratio
Fhigh image lag
FPLUMBICON TV camera (suitable for cardiology)
Flower image lag (follow up of organ motions)
Fhigher quantum noise level
FCCD TV camera (digital fluoroscopy)
Fdigital fluoroscopy spot films are limited in resolution, since they depend on the TV camera (no better than about 2 lp/mm) for a 1000 line TV system
TV camera and video signal (II)
Vidicon (tube) TV Camera
camera tube have a diameter of approximately
1 inch and a length of 6 inches.
Parts of the camera tube
lGlass envelope
lElectron gun (Cathode)
lControl grid
lElectrostatic grids
lTarget
Camera Tube steps
lLight is received by the camera tube.
lThe light from the II is received at the face plate of the target assembly.
lElectrons are formed into an electron beam (by the control grid) at the electron gun.
lElectrons are burned off by thermionic emission then focused and accelerated to the target. (made of antimony trisulfide)
Target of the Camera Tube
lThe electrons scan the signal plate similar to reading a page.
lStarting in the upper left across to the right, then back to the left to right.
lThis is called an active trace.
lThe movement of the electron beam produces a RASTER pattern.
lThe same pattern occurs in the TV monitor.
lThe signal plate sends the electrical video signal to the control unit which amplifies the signal and synchronizes the pulses between the camera tube and the TV monitor.
lThis synchronization
Vidicon Target Assembly
Viewing Systems
lVideo camera charge-coupled device (CCD)
lVideo monitor
lDigital
Video Viewing System
lClosed circuit television
lVideo camera coupled to output screen and monitor
lVideo cameras
lVidicon or Plumbicon tube
lCCD
Synchronization (Sync Signals)
TV camera and video signal (V)
TV Monitor
TV MONITOR
lCRT – Cathode Ray Tube
lMuch larger than camera tube – but similar function
lThe electrons are synchronized by the control unit – so they are of the same intensity and location as the electrons generated by the pick up (camera) tube.
TV Monitor
lThe TV monitor contains the picture tube called cathode ray tube (CRT).
lIt works like the camera tube.
lWith an electron gun and control grids the electron beam is fired toward the anode.
lThe TV screen contains small fluorescent crystals
Video Field Interlacing
Different types of scanning
Line pair gauges
lTwo fields = a frame (525 lines)
lIt take 1/30 of a second.
lTo prevent flicker, two fields are interlaced to form on television frame.
lThere are 60 fields and 30 frames per second.
lThe eye cannot detect flickering above 20 frames/sec.
RASTER Pattern
lThe electron beam moves in the same raster pattern as in the camera tube.
lThe signal consists of many individual pulses corresponding to the individual location on the camera tube target.
lThe varying voltage pulses are later reassembled into a visible in by the TV monitor.
TV RESOLUTION-Vertical
lConventional TV: 525 TV lines to represent entire image. Example: 9” intensifier (9” FOV)
–9” = 229 mm
–525 TV lines/229 mm = 2.3 lines/mm
–Need 2 TV lines per test pattern line-pair
–(2.3 lines/mm) /2 lines/line-pair = 1.15 lp/mm
lActual resolution less because test pattern bars don’t line up with TV lines. Effective resolution obtained by applying a Kell Factor of 0.7.
Example: 1.15 x 0.7 Kell Factor = 0.8 lp/mm
Kell Factor
lThe ability to resolve objects spaced apart in a vertical direction.
lMore dots = more scan lines = more/better resolution
lKell factor for 525 line system is 0.7
KELL FACTOR
VERTICAL RESOLUTION
ABILITY TO RESOLVE OBJECTS SPACED APART IN A VERTICAL DIRECTION
MORE DOTS(GLOBULES) = MORE SCAN LINES = MORE/BETTER RESOLUTION
lRATIO OF VERTICAL RESOLUITON
l # OF SCAN LINES
lKELL FACTOR FOR 525 LINE SYSTEM
lIS 0.7
TV RESOLUTION-Horizontal
lAlong a TV line, resolution is limited by how fast the camera electronic signal and monitor’s electron beam intensity can change from minimum to maximum.
lThis is bandwidth. For similar horiz and vertical resolution, need 525 changes (262 full cycles) per line. Example (at 30 frames/second):
262 cycles/line x 525 lines/frame x 30 frames/second
= 4.2 million cycles/second or 4.2 Megahertz (MHz)
Bandpass/Horizantal Resolution
lHorizontal resolution is determined by the bandpass.
lBandpass is expressed in frequency (Hz) and describes the number of times per second the electron beam can be modulated.
lThe higher the bandpass, the better the resolution
TV SYSTEMS
lImages are displayed on the monitor as individual frames – which tricks the eye into thinking the image is in motion (motion integration)
l15 f/sec – eye can still see previous image
lWeakest Link - 2 lp /mm resolution
lReal Time
Final Image
lThe result of hundreds of thousands of tiny dots of varying degrees of brightness.
lThese dots are arranged in a specific patterns along horizontal scan lines.
lUsually 525 scan lines.
lThe electron gun within the picture tube scans from top to bottom in 1/60 of a second, (262 1/2 lines) called a field.
TABLE MOVEMENT
horizonatal to upright ~ 30 sec
End of Week 1 Day 2
Digital Fluoro
DIGITAL FLUORO
DIGITAL Fluoro System
ADC –
lANALOG TO DIGITAL CONVERTER
lTAKE THE ANALOG ELECTRIC SIGNAL CHANGES IT TO A DIGITAL SIGNAL
lTO MONITOR –
lBETTER RESOLUTION WITH DIGITAL UN
Digital Fluoroscopy
lUse CCD to generate electronic signal
lSignal is sent to ADC
lAllows for post processing and electronic storage and distribution
Video Camera Charged Coupled Devices (CCD)
lOperate at lower voltages than video tubes
lMore durable than video tubes
lSemiconducting device
lEmits electrons in proportion to amount of light striking photoelectric cathode
lFast discharge eliminates lag
CCD’s
Modern Digital Fluoro System
under table tubes
Remote – over the table tube
Newer Digital Fluoroscopy
lImage intensifier output screen coupled to TFTs
lTFT photodiodes are connected to each pixel element
lResolution limited in favor of radiation exposure concerns
Digital – CCD
using cesium iodide
lExit x-rays interact with CsI scintillation phosphor to produce light
lThe light interact with the a-Si to produce a signal
lThe TFT stores the signal until readout, one pixel at a time
CsI phosphor light detected by the AMA of silicon photodiodes
Digital Uses Progressive Scan
l1024 x 1024
lHigher spatial resolution
lAs compared to 525
l8 images/sec
l(compared to 30 in 525 system)
DSA & POSTPROCESSING
DSA
Mobile C-arm Fluoroscopy
Fluoro & Rad
Protection INTRO
RHB
Regulatory Requirements
1. Regarding the operation of fluoroscopy units
2. Regarding personnel protection
3. Regarding patient protection
Fluoroscopic Positioning Previewing
lRadiographers are trained in positioning
lUnnecessary radiation exposure to patient is unethical
lFluoroscopic equipment should not be used to preview patient’s position
Patient Protection
lTabletop exposure rate
lMaximum 10 R/min
lTypically 1 – 3 R/min
lSome books ave is 4 R/min **
Patient Protection
lMinimum source-to-skin distance
l12” for mobile equipment
l15” for stationary systems
lAudible alarm at 5 mins.
lSame rules for collimation
Patient Protection
lTypical exposure rates
lCinefluorography
l7.2 R/min
lCassettes
l30 mR/exposure
l105 mm film
l10 mR/exposure
Protection of Radiographer and Radiologist
lSingle step away from the table decreases exposure exponentially
lBucky slot cover
lLead rubber drape
lRadiologist as shielding
Protection of Others
lRadiographer’s responsibility to inform others in the room to wear lead apron
lDo not initiate fluoroscopy until all persons have complied
PUBLIC EXPOSURE
l10 % OF OCCUPATIONAL
lNON MEDICAL EXPOSURE
l.5 RAD OR 500 MRAD
lUNDER AGE 18 AND STUDENT
l.1 rem 1 mSv
COLLIMATION
lThe PATIENT’S SKIN SURFACE
lSHOULD NOT BE CLOSER THAN
l___________ CM BELOW THE COLLIMATOR?
l____________ INCHES?
Protection
Regulations about the operation
lFluoroscopic tubes operate at currents that range from0.5 to 5 mA with 3 the most common
lAEC rate controls: equipment built after 1974 with AEC shall not expose in excess of 10 R/min; equipment after 1974 without AEC shall not expose in excess of 5 R/min
Other regulations
lMust have a dead man switch
lMust have audible 5 min. exposure timer
lMust have an interlock to prevent exposure without II in place
lTube potential must be tested (monitored)weekly
lBrightness/contrast must be tested annually
lBeam alignment and resolution must be tested monthly
lLeakage cannot exceed 100mR/hr/meter
Fluoroscopy exposure rate
lFor radiation protection purposes the fluroscopic table top exposure rate must not exceed 10 mR/min.
lThe table top intensity should not exceed 2.2 R/min for each mA of current at 80 kVp
Patient Protection
wA 2 minute UGI results in an exposure of approximately 5 R!!
wAfter 5 minutes of fluoro time the exposure is 10-30 R
wUse of pulsed fluoro is best (means no matter how long you are on pedal there is only a short burst of radiation)
wESE must not be more than 5 rads/min
Rad Protection
lAlways keep the II as close to the patient as possible to decrease dose
lHighest patient exposure happens from the photoelectric effect (absorption)
lBoost control increases tube current and tube potential above normal limits
lMust have continuous audible warning
lMust have continuous manual activation
ESE FOR FLUORO
lTLD PLACED AT SKIN ENTRACE POINT
l 1 –
lINTERGRAL DOSE –
l100 ERGS OF TISSUE = 1 RAD EXPOSURE
lOR 1 GM RAD = 100 ERGS
SSD – TUBE TO SKIN DISTANCE
lFIXED UN
l18” PREFERRED
l15 “ MINIMUM
MOBILE UN
l12’ MINIMUM
PATIENT PROTECTION
lLIMIT SIZE OF BEAM
lBEAM ON TIME
lDISTANCE OF SOURCE TO SKIN
lPBL
lFILTRATION (2.5 mm Al eq) @ 70
lSHEILDING
lSCREEN/FILM COMBO
GONAD SHIELDING
lMUST BE . 5 MM OF LEAD
lMUST BE USED WHEN GONADS WILL LIE WITHING 5 CM OF THE COLLIMATED AREA (RHB)
lKUB. Lumbar Spine Pelvis
l male vs female shielding
Gonad shielding & dose
l♀ receive 3x more dose than
l♂ for pelvic x-rays
l1 mm lead will reduce exposure (primary) by about 50% ♀
l by about 90 – 95 % ♂
KEEP I.I. CLOSE TO PATIENT
Over vs under the table
fluoro tubes
Framing and patient dose
syll = Pg 31
lThe use of the available film area to control the image as seen from the output phosphor.
lUnderframing
l Exact Framing, (58 % lost film surface)
lOverframing,(part of image is lost)
lTotal overframing
EXPOSURE RATES FLUORO
lMA IS 0.5 MA TO 5 MA PER MIN
lAVE DOSE IS 4 R / MIN
lIF MACHINE OUTPUT IS 2 R/MA/MIN = WHAT IS PT DOSE AT 1.5 MA FOR 5 MIN STUDY?
l15R
EXPOSURE RATES FOR FLUORO
lCURRENT STANDARD
l10 R/MIN (INTENSIFIED UN
lHLC: BOOST MODE 20 R/MIN
lOLD (1974) NO ABC NON IMAGE INTES
l5 R/MIN
DOSE REGULATIONS
lBEFORE 1974 - AT TABLETOP
l5R/MIN (WITHOUT AEC)
l5R/MIN (WITHOUT AEC) – BOOST MODE
lAfter 1974 with AEC
l10 R/MIN 20R/MIN BOOST
RADIATION PROTECTION
The Patient is the largest scattering object
lLower at a 90 DEGREE ANGLE from the patient + PRIMARY BEAM
AT 1 METER DISTANCE -
l1/1000 OF INTENSITY PRIMARY XRAY or 0.1%
BUCKY SLOT COVER
.25 MM LEAD
Bucky Slot Cover
ISOEXPOSURE CURVES
PERSONNEL PROTECTION
lSCATTER FROM THE PATIENT
lTABLE TOP, COLLIMATOR, TUBE HOUSING, BUCKY
lSTRAY RADIATION – LEAKAGE OR SCATTER RADIATION
TOWER CURTAIN
.25 MM LEAD EQ
Lead curtain & dose reduction
Pulsed Fluoro
lSome fluoroscopic equipment is designed for pulsed-mode operation. With the pulsed mode, it can be set to produce less than the conventional 25 or 30 images per second. This reduces the exposure rate.
lCollimation of the X ray beam to the smallest practical size and keeping the distance between the patient and image receptor as short as possible contribute to good exposure management.
PERSONNEL PROTECTION
lSTANDING BEHIND A PROTECTIVE PRIMARY (1/16TH pb) BARRIER:
lPRIMARY RADIATION EXPOSURE – 99.87% REDUCED
lPORTABLE BARRIER = 99 % REDUCTION
PERSONNEL PROTECTION
lPROTECTIVE APRONS –
l0.25 PB = 97% ↓ TO SCATTER
l0.5 PB = 99.9% ↓ TO SCATTER
lTHYROID SHEILDS (0.25 & 0.5)
lGLOVES (0.25 & 0.5)
PERSONNEL PROTECTION
MONITORING
lFILM BADGE
lTLD
lPOSL
lPOCKET DOSIMETER
lRING BADGE
PERSONNEL PROTECTION
MONITORING
lDOSE LIM
lWHOLE BODY
lEYES
lEXTREMITIES (BELOW ELBOW/KNEES)
Report at least every quarter
Preserved for a minimum of 3 years
RHB NOTIFICATION (EXP IN 24 HOURS)
(RP Syllabus – pg 68)
IMMEDIATE reporting – WITHIN 24 HOURS
lTOTAL DOSE OF 25 rems
lEye dose – 75 rem
lExtremity – 250 RADS
OVEREXPOSURE – received w/in 24 hrs
Must be ReportedWITHIN 30 DAYS
lTOTAL DOSE OF 5 rems
lEye dose – 15 rem
lExtremity - 50 REMS
LICENSE RENEWAL
lWITHIN 30 DAYS OF EXPRIATION
lNOTIFICATION OF CHANGE OF ADDRESS
HIGH RADIAITON AREA –
l100 mRem ( 0.1 rem / (1 msV)
l@ 30 cm from the source of radiaton
RADIAITON AREA –
lRHB: 5 mRem ( 0.005 rem / (.05 msV)
l@ 30 cm from the source of radiation
lPUBLIC 2 mrem per week* (STAT)
A “controlled area” is defined as one
lthat is occupied by people trained in radiologic safety
lthat is occupied by people who wear radiation monitors
lwhose occupancy factor is 1
RHB “RULES” RHB RP PG61
lLICENTIATES OF THE HEALING ARTS
(MD, DO, DC, DPM)
lMUST HAVE A
lRADIOLOGY SUPERVISOR & OPERATORS PERMIT & CERTIFICATE
lTO OPERATE OR SUPERVISE THE USE OF X-RAYS ON HUMANS
lSUPEVISORS MUST POST THEIR LICENSES
RHB “RULES” RHB RP PG62
lALL XRAYS MUST BE ORDERED BY A PHYSICIAN
lVERBAL OR WRITTEN PRESCRIPTION
lSee Section C – “Technologist Restrictions”
DOSE
lCINE - 2mR per frame (60f/sec)
l400 mr per “look”
Declared Pregnant Worker
lMust declare pregnancy – 2 badges provided
l1 worn at collar (Mother’s exposure)
l1 worn inside apron at waist level
Under 5 rad – negligible risk
Risk increases above 15 rad
Recommend abortion (spontaneous) 25 rad
l(“Baby exposure” approx 1/1000 of ESE)
lwww.ntc.gov/NRC/RG/08/08-013.html
Breakthrough performances. Breakthrough capabilities. Introducing the Precision™ 500D all-digital R&F system, the first system of its kind to offer you: The Precision 500D's new, all-digital imaging chain ensures outstanding results in even the most challenging procedures: The Precision 500D incorporates all the dose-lowering capabilities that advanced technology has to offer.Capabilities such as fluoro store to hard disk and automatic last image hold are standard - capabilities that often permit direct diagnosis without extra radiographic exposures. But there's more: Precision 500D is the product of Six Sigma design processes. This incredibly easy-to-use, integrated console provides single-point control for most exams. With the Precision 500D touch screen, exam set-up is as simple as selecting the patient from a PACS-generated worklist … and choosing the appropriate exam. The system automatically selects the best protocols. The Overhead Tube Stand interface gives you control over parameters from kV to mAs, so you can make protocol adjustments without leaving the room. Unlike previous generations of R&F technology, the Precision 500D incorporates advanced DICOM SPS and PPS protocols. That makes it a comprehensive connectivity solution - one that streamlines procedure and image management, by letting you: Day in, day out, the Precision 500D performs. The Precision 500D offers a host of features designed to ensure consistently reliable operation in even high-throughput environments. Just a few examples: The EasyDiagnost Eleva is a conventional (nearby controlled) R/F system designed to perform a wide range of applications from gastrointestinal, various iodine and vascular procedures to standard radiography. Easy to operate, fast and reliable to use, this system offers the ability to customize protocols and techniques for individual physician preferences. You’ll find increased productivity through: Based on open standards, the EasyDiagnost Eleva seamlessly integrates into any hospital network. Uniquely Philips Created to assist in faster, more confident diagnoses, the EasyDiagnost features: Built-in viewing intelligence The EasyDiagnost Eleva features ViewForum, Philips view and processing software that allows access to multi-modality images and information at the workspot in each individual's preferred lay-out. Create a DRF room Extend the application of your EasyDiagnost Eleva. The combination of our high-end digital vertical stand (or digital in-table detector) and the EasyDiagnost Eleva with ceiling suspension, easily manages both high-quality digital radiography as well as fluoroscopy (DRF) applications in just one room. With the new DRF room solution you will be able to:Precision 500D - Digital R&F System
Overview
High quality, low dose imaging over the full range of R&F Procedures
Improved dose management
Amazingly user-friendly interface
New standards for throughput and productivity
DICOM 3.0 connectivity
Engineered for long-term reliability
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DuoDiagnost's smart combination of radiography and fluoroscopy in one system provides you with comprehensive clinical functionality in a cost-effective package for virtually all applications. As a remote-controlled fluoroscopy system, DuoDiagnost is suitable for all standard R/F procedures. However, at the mere touch of a button the system is converted into a universal radiography unit – without the need for a second X-ray tube – for all routine radiography procedures including lateral, thorax and tomography studies.
DuoDiagnost offers:
- The radiography flexibility you want, combined with the fluoroscopy functionality you need
- A compact design that allows for installation in small rooms
- Digital operation with all benefits of digital technology: time, cost and X-ray dose saving
- Enhanced throughput with an additional vertical Bucky
- Seamless integration into your DICOM network
- Excellent image quality at a low X-ray dose with Philips DoseWise concept
Dual functions enhance return on investment The DuoDiagnost offers a far better price/performance ratio than separate radiography and fluoroscopy systems. At the same time it provides the full functionality of a fluoroscopy and a Bucky system with all its projection flexibility. The combination of a compact and flexible design and a single X-ray tube reduces space and room preparation requirements, decreasing initial costs. |  |
Today’s imaging is digital
The benefits of digital acquisition and fluoroscopy are clear: lower costs, greater efficiency and improved image quality. DuoDiagnost is prepared for digital technology, so you can plan your digital future according to your specific situation.
- For fluoroscopy: choose from a digitally prepared or a digital version
- For radiography: acquire digital images with Philips Computed Radiography (PCR) Eleva
If digital imaging is not part of your plan right now, DuoDiagnost can easily be upgraded to digital later – in less than half a day.
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The OmniDiagnost Eleva is a multifunctional remote-controlled X-ray system combining digital, CR and conventional imaging. Offering exceptional flexibility, the OmniDiagnost Eleva delivers excellent performance across a variety of applications, while still maintaining your specific application needs.
The OmniDiagnost Eleva offers:
- Unique scan principle - The X-ray beam moves around your patients so they can remain stationary during all scan movements.
- Exceptional accessibility - The left- or right side suspended tabletop provides exceptional accessibility.
- A broad application range - From radiography to RF including tomography and vascular/interventional procedures.
- Freedom of movement control - You can control the complete system from any location in the exam or control room.
- Eleva concept - Unique technology which enables exam-, operator- and patient-related pre-sets to be programmed to each user's preferences, increasing efficiency and reducing potential operator error.
- DoseWise - Philips' unique approach to dose management
Patient Comfort With our OmniDiagnost Eleva's unique scan principle, your patients remain stationary while the X-ray beam moves around the patient, which increases patient comfort and decreases possible hazards, especially during interventions. The self-centering curved tabletop ensures patient comfort and safety and the one-side suspension provides exceptional accessibility and easy patient transfer. |  |
Wide Application range
The OmniDiagnost Eleva is designed to perform a wide range of clinical applications.
- Various Iodine (ERCP, HSG, Phlebography). The OmniDiagnost Eleva's one-side suspended table is also available in a - especially suitable for ERCP examinations - left sided tabletop configuration.
- Gastro Intestinal (Esophagus, Stomach, optional ColonMap). The table tilt +90/-90 and FluoroGrab make the OmniDiagnost Eleva very well suited for GI exams.
- Interventions (Stent, Dilation). The one-side suspended table offers your staff an exceptional accessibility to the patient and you can still manipulate the system from the tableside with great efficiency.
High flexibility for urological interventions
 | Urological interventions require the utmost flexibility from an X-ray system. The MultiDiagnost Eleva multipurpose X-ray system with Urology package combines advanced radiographic functionality with dedicated urological tools to support fast and secure interventions. It provides comfortable access to the region of interest during ureteroscopy and superb imaging during urodynamics. |
Perform urological interventions with speed and confidence
- Comfortable access to the patient’s region of interest due to split tabletop and special accessories (leg supports and drain bag) for urological interventions.
- The system’s high projection flexibility provides superb anatomical insight during ureteroscopy.
- Full fluoroscopic capabilities, including fluoroscopic image grabbing, make the system especially suitable for dynamic studies.
- The C-arc of the MultiDiagnost Eleva multipurpose X-ray system moves around the patient to obtain exceptional visibility of the anatomy from various angles.
The MultiDiagnost Eleva supports dedicated Urodynamics studies
To support urodynamic studies a specially designed micturation seat can be mounted on the table. With the flexible C-arc any projection frontal, oblique or lateral is possible without moving the patient. A dedicated digital interface to support synchronization of the acquired images with pressure measurements makes the MultiDiagnost Eleva a superb system for Urodynamics.
Applications
Extra comfort, accessibility and flexibility for Pain Management
Extra support for Pain Management
MultiDiagnost Eleva with 3D-RX gives insight during procedures During procedures, such as vertebroplasty and biopsies, 3D reconstructions can be created in a few seconds to check needle trajectory and positioning. It provides valuable feedback during pain management examinations that enables clinicians to adjust the needle path or insertion.
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Projection flexibility for Gastrointestinal (GI) diagnostics & interventions
 | The gastrointestinal (GI) tract can host a wide variety of diseases – in patients of all ages. Effective diagnosis and treatment requires the utmost flexibility from your medical equipment.
The MultiDiagnost Eleva multipurpose X-ray system with its gastrointestinal package can visualize anatomy from any angle. Its dynamic video fluoroscopy can show the GI tract function in real time. |
The system’s 3D imaging provides insight into complex structures like the gall duct in the liver.
Perform the full range of GI diagnostics & interventions
- The projection flexibility offered by the C-arc of the MultiDiagnost Eleva provides excellent anatomical insight that supports efficient diagnostics and interventions.
- High resolution images visualize the smallest anatomical details and support both GI diagnostics and interventions on the same system.
- Barium swallow and speech therapy examinations can be done with the patient remain sitting in a (wheel)chair.
- Left suspended table available for ERCP fluoroscopy procedures.
- For patient’s comfort during defecography procedures a special stool is available.
Increase patient comfort during GI procedures
The C-arc moves around the table and patient so that patients can remain stationary during examinations of the gastrointestinal tract. Patients can be imaged in a sitting position in a wheelchair, standing or lying on the tabletop. This increases patient comfort during lengthy GI procedures.
Enhanced insight during ERCP procedures
For optimal access to the patient during an ERCP procedure, a left suspended table is available. The C-arc’s projection flexibility makes it possible to view the anatomy from various angles which gives additional clinical information for treatment planning. In addition the 3D-RX imaging gives unrivaled anatomical insight.
Applications
Better insight into anatomy for Orthopedics
More flexibility for Orthopedics
Treatment planning for Orthopedics Weight bearing 3D reconstructions can be created in a few seconds to provide anatomical insight before carrying out orthopedics procedures. These images show a high level of anatomical detail to support treatment planning.
Spine and Legs Overview on multipurpose X-ray system Philips exclusive Spine and Legs application packages provide a powerful digital tool for reconstructing and viewing a complete spine and leg overview. The Spine application can be used to measure the degree of scoliosis (Cobb’s angle), vertical (mis)alignment of the vertebrae column and femur head height differences. The Legs application can be used to measure lower limb abnormalities.
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 | For vascular diagnostics and interventions, conventional angiography is often required in addition to MR and CT angiography. It is essential to obtain a detailed visualization of complex vasculature from multiple viewing angles. High resolution digital subtraction images support detailed diagnosis and treatment planning, while 3D visualization provides additional insight. The Philips MultiDiagnost Eleva with the Vascular package provides all of this and more. |
Supports full range of vascular diagnostics and interventions
- Extensive vascular tools, like Bolus Chase, vessel analysis and virtual stenting are available at your fingertips.
- System moves around the patient to provide exceptional visibility over full body length.
- 3D reconstructions provide detailed anatomical insight in one run within seconds to support vascular interventions.
- This combination is ideal for smaller hospitals, start-up departments and out-patient facilities or as a back-up angio suite for larger hospitals.
Multipurpose X-ray with advanced X-ray Vascular Analysis
The X-ray Vascular Analysis package provides advanced vascular processing and viewing features for diagnostics and interventions. Automatic Vascular Analysis (AVA) can be applied to the digital subtraction images and uses automatic vessel contour detection to provide professional quantitative data about vessel diameter and the stenotic index. The automatic vessel analysis applied to 3D reconstructions is fully automatic and even provides virtual stenting to assess the stent to be used.
Applications
Multipurpose trauma X-ray system supports fast and confident diagnosis
Superb visibility and flexibility on one multipurpose trauma X-ray system
Perform multiple trauma imaging in the same room The MultiDiagnost Eleva multipurpose X-ray system with flexible C-arc supports a full range of imaging procedures so that you do not have to move the trauma patient. High quality 3D reconstructions can be used to visualize complex fractures. High resolution digital subtraction angiography provides detailed imaging of internal bleeding or ruptures around a fracture. All digital imaging information can be stored to PACS in DICOM format for immediate access by surgeons or other specialized disciplines in the hospital.
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