Fluoroscopy Notebook 10

In 1895 Roentgen knew that there was a way to watch live x-ray when he saw his fingers
move between a screen and the tube. As the years went on more people began to try to develop
this technology, amongst them was Thomas Edison. In 1937 Irving Langmuir patented the image
intensifier and 11 years later J.W. Coltman increased the brightness on the image intensifier by
1000 times. 5 years later the first commercial image intensifier was made. As time went on, it
was suspected that technicians needed to be safer while performing the exams, and different
tactics were used to try to prevent as much primary radiation as they could from getting to the
technicians and radiologists. Thus, lead shields, aprons, gloves and glasses were made.

There are two types of fluoroscopy units. There are fixed units, which are units that are
fixed to the room they are in and are used for routine exam studies done in the department. There
are also mobile units that are found commonly in operating rooms and emergency rooms, these
are units that are able to be moved to where they are needed. Both units have an image
intensifier. The image intensifier contains an image receptor, a vacuum tube, an input window
and phosphor layer, electrostatic lenses, an output window with a phosphor layer, as well as
protective housing and shielding. The purpose of the image intensifier is to take one photon and
amplify it to light photons. The light photons produce photoelectrons within the photocathode,
which then produce an abundance of light photons at the output screen. Below displays the
components of an image intensifier as well as the two different types of fluoroscopic units:
 Image intensifiers were introduced so that the radiologist did not have to adjust the rods
in their eyes to adjust to the dark, because they did not have to do this anymore the accuracy of
their diagnosis increased as well due to the need for the cones ability when in daylight mode.

When a photon first hits the fluorescent screen of the image intensifier it absorbs the x-
rays and puts out light photons that then, immediately, hit the photocathode. Photoelectrons are
then shot to the anode and the output screen, while being directed by electrostatic lenses. When
the electrons reach the output screen is absorbs the electrons and emits light photons to the
monitor. The input fluorescent screen contains a layer of cesium iodide (CsI) phosphors which
absorb some of the beam, the output screen, behind the positively charged anode, consists of
silver-activated zinc-cadmium sulfide phosphor (ZnS-CdS: Ag). The output screen allows a
resolution of around 70 lp/mm, when the electrons strike the screen a green light photons exit the
tube, in order to avoid these photons from causing undesired exposure to the image a filter was
added to absorb these photons.
 The fluoroscopy units consist of a carriage, the arm that supports the equipment. The
fluoroscopy units include the generator, tube, collimator, filtration, a table, in some cases a grid,
an image intensifier, optic coupling, a video camera, and a monitor. In fixed units a distance
from the tube to the patient has to be at least 15 inches, this is maintained because of how the
unit is assembled, however in mobile units the radiographer has to remain conscious and ensure
that there are at least 12 inches between the patient and the tube.

Filters are used in fluoroscopy that absorbs scattered photons as well as soft x-rays, this
allows the patients dose to go down by 50%. There are some exams that are able to use much
more filtration because of the amount of detail and exposure that is needed. Grids are not
typically used because of the small field of view as well as the ability to easily manipulate the
equipment to create an air gap that can be used in lieu of a grid. Each unit has a viewing system;
this allows the recordings to be seen immediately if an automatic gain control is used, or with a
little bit of lag if an automatic brightness control is used, this is because it corrects the exposure
factors while the AGC does not. The viewing system also allows the technologist to save images.
 Contrast, resolution, distortion and quantum mottle are all factors that are to be
considered during fluoroscopy as well. One of the main problems that occurs during fluoroscopy
is vignetting which is a shape distortion that occurs when electrons are repulsed by each other
going off into different directions, particularly towards the edges of the image, beam divergence
also is a source for distortion along the edges. One of the errors that can occur while using
fluoroscopy is to maintain safety standards, patients can get radiation burns if the x-ray beam is
not consistently moved and only on one spot or if the source to skin distance is closer than the
mandated limits, the tabletop exposure rate should not exceed 10R/min, usually this is not a
concern as it is typically within 1-3R/min. Fluoroscopy time should not exceed 5 minutes.

Another concern is occupational safety; any personnel that are near the fluoroscopy units
should have an understanding of where the safest place to be is, as well as how to ensure they
have proper protection. The radiographer should always check and make everyone aware that an
x-ray will be taken. They should stand in a spot either far back from the unit, or elevated, but not
within a 90 degree angle of the primary bean if avoidable, they also should not stand near the
tube as that is where the highest amount of dose is recorded. The closer the patient is to the II the
less scatter radiation there will be for everyone.