In the name of God

1. In the name of God

2. Medical Imaging(Fluoroscopy) By: Payam Khoshkenar (8533043)

4. What is Fluoroscopy? Fluoroscopy is an imaging technique commonly used by physicians to obtain real-time images of the internal structures of a patient through the use of a fluoroscope. In other word, fluoroscopy is a technique for obtaining “live” (X-Ray) images of a living patient – it’s like an x-ray TV camera. Fluoroscopy is a type of medic al imaging that shows a continuous x-ray images on a monitor, much like an x-ray movie. Thus, the common name for production of real-time images.

5. History The beginning of fluoroscopy can be tracked back to 8 November 1895 when Wilhelm Roentgen noticed the barium platinocyanide screen fluorescing as a result of being exposed to what he would later call x-rays. Within months of this discovery, the first fluoroscopes were created.

6. Historically, fluoroscopy was done the first time by W.C. Roentgen when he first discovered the new kind of rays in 1895. For medical purposes the first fluoroscopy units were used as early as 1896.

7. Kinds of Fluoroscopes Early fluoroscopes were simply cardboard funnels, open at narrow end for the eyes of the observer, while the wide end was closed with a thin cardboard piece that had been coated on the inside with a layer of fluorescent metal salt.

8. Early Fluoroscopes

9. The fluoroscopic image obtained in this way is rather faint. Thomas Edison quickly discovered that calcuim tungstate screens produced brighter images and is credited with designing and producing the first commercially available fluoroscope. In its infancy, many incorrectly predicted that the moving images from fluoroscopy would completely replace the still x-ray radiographs, but the superior diagnostic quality of the earlier radiographs prevented this from occuring.

10. Different parts of fluoroscopy equipments • A patient table • X-ray generator • X-ray tube • Image intensifier • Flat panel detectors • Image display system

11. The first fluoroscopes consisted of and x-ray source and fluorescent screen between which the patient would be placed. As the x-rays pass through the patient, they are attenuated by varying amounts as they interact with the different internal structures of the body, casting a shadow of the structures on the fluorescent screen.

12. Fluoroscopy revolution The fluoroscopic technique was revolutionized when the image intensifier was introduced. 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.

13. Subsequent improvements included the coupling of, at first, video cameras and, later, CCD(charge-coupled device) cameras to permit recording of moving images and electronic storage of still images.

14. The fluoroscopy units were equipped with a fluorescent screen consisting of copper activated zinc cadmium sulphide that emitted light in the yellow-green part of the visible spectrum. Modern image intensifiers no longer use a separate fluorescent screen. Instead, a caesium iodide phosphor is deposited directly on the photocathode of the intensifier tube. On a typical general purpose system, the output image is approximately 105 times brighter that the input image.

15. Flat-panel detectors The introduction of flat-panel detectors allows for the replacement of the image intensifiers in fluoroscope design. Flat-panel detectors offer increased sensitivity to x-rays, and therefore have the potential to reduce patient radiation dose. Resolution is also improved and motion blurring is reduced. Contrast ratio is also improved.

16. Operation The fluoroscope is maneuvered in such a way that the patient, and anatomical area of interest, is positioned between the x-ray tube and the image intensifier. The operator uses the control console to set imaging parameters. The intensity of the x-rays is controlled with the milliamperage (mA) setting and the energy and intensity of the x-rays are controlled with the peak kilovoltage (kVp) setting.

17. A typical fluoroscopy image setting is 70 kVp at 2 mA.

18. Viewing the output film • Viewing with eyes • Viewing with TV camera

19. Brightness control • Automatic Gain Control (AGC) • Automatic Brightness Control (ABC) • The Brightness gain comprises a flux gain and minification gain. • Flux gain is amplification of photon number • Minification gain is concentration of photons from a large input screen onto a small output screen

22. Recording of fluoroscopy film The fluoroscopy films are recorded by photo-spot cameras.

23. Due to the limited light produced from the fluorescent screens, early radiologists were required to sit in a darkened room. Red adaptation goggles were developed by Wilhelm Trendelenburg in 1916 to address the problem of dark adaptation of the eyes.

24. Risks Because fluoroscopy involves the use of x-rays, a form of ionizing radiation, all fluoroscopic procedures pose a potential health risk to the patient. Continuous fluoroscopy for long periods can deliver a significant radiation dose. Therefore most systems have a pulsed fluoroscopy mode.

25. Uses of fluoroscopy • Fluoroscopy 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. • Fluoroscopy, as an imaging tool, enables physicians to look at many body systems, including the skeletal, digestive, urinary, respiratory, and reproductive systems. • Fluoroscopy may be perform to evaluate specific areas of the body, including the bones, muscles and joints, as well as solid organs such as the heart, lung, or kidneys.

26. Fluoroscopy is used in many types of examinations and procedures. Some examples include: • Barium x-rays and enemas (BE) • Catheter insertion • Orthopedic surgery • Locating foreign bodies • Viscosupplementation injection • Image-guided anesthetic injection

27. Barium x-rays and enemas (BE) In barium x-rays, fluoroscopy used alone allows the physician to see the movement of the intestines and the barium moves through them.

28. Catheter insertion In cardiac catheterization, fluoroscopy is added to enable the physician to see the flow of blood through the coronary arteries in order to evaluate the presence of arterial blockages. Also is used in intravenous catheterization.

29. Orthopedic surgery To view fractures and fracture treatments that is minimally invasive procedure used to treat fractures of the vertebrae of the spine.

30. Viscosupplementation injection A procedure in which a liquid substance that acts as a cartilage replacement or supplement is injected into the knee joint

31. Locating foreign bodies • Placement of a PICC (peripherally inserted central catheter) • Placement of a weighted feeding tube (e.g. Dobhoff) into the duodenum after previous attempts without fluoroscopy have failed • Implantation of cardiac rhythm management devices (pacemakers, implantable cardioverter defibrillators)

33. Thanks for your attention

34. Refrences: www.spinuniverse.com www.acadiana imaging.com www.optimalpacing.com www.msn.com www.wikipedia.com