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RAD413 > fluroscopic systems: image intensifier (traditional) > Flashcards

fluroscopic systems: image intensifier (traditional) Flashcards

1
Q

what is fluroscopy used for

A

to retrieve static image of body part

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2
Q

what is R & F system

A

radiography and fluoroscopy system

  • a type of medical imaging that shows a continuous X-ray image on a monitor
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3
Q

be aware that you need a static image for archiving in fluroscopy

A
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4
Q

what is the difference between a dynamic and static image in fluroscopy

A

dynamic = a picture that has a certain amount of motion e.g only a swallow

static = fixed image

(fluroscopy uses dynamic imaging)

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5
Q

be aware that there is blur/lag with fast movement in dynamic imaging

A
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6
Q

give an example of a fluorescent molecule found in producing fluorescence

A

caesium iodid

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7
Q

explain the process of how fluorescence is made

A
  • fluorescent molecule excited by incident xray photon
  • electron in an orbiting shell jumps into a shell in a higher state but is unstable and drops back down
  • energy is emitted to return to ground state in the form of visible light
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8
Q

because fluroscopy is more efficient than using xrays directly to create an image, what does this mean about patient dose

A
  • fewer xrays used due to increased efficiency
  • lower patient dose
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9
Q

what are the 3 general configurations of fluroscopic machinery/system

A
  • under couch
  • over couch
  • C arm
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10
Q

what is under couch fluroscopy

A
  • xray tube underneath a couch for the patient to lie on and image capture above
  • uses image intensifier
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11
Q

what is over couch flurosopy

A
  • image receptor under couch and xray tube over head
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12
Q

what is c arm flurosocpy

A

mounted on opposite sides of c arm to be able to move around the patient

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13
Q

why type of fluoroscopic machinery is used in theatre

A

c arm

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14
Q

what are 3 reasons why under couch fluroscopy (traditional R&F) superior

A
  • image receptor can come down close to the patient for best image quality
  • most scattered radiation downwards away from operator eyes
  • can Han lead rubber stops off the side of the image receptor to protect operator
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15
Q

what are some negatives of under couch fluoroscopy

A
  • needs separate xray tube to do plain radiography as mixed application room
  • needs wall bucky
  • large screening carriage needs to be pushed backwards to pelvis or similar
  • high to do extremities on
  • have to remember to move the bucky to top or bottom end of table to use screening carriage
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16
Q

why was an over couch/remote system invented after the under couch/traditiional system

A
  • allows operator easier access to patient for interventional procedures with sterile area
  • less claustrophobic
  • operator can step away from scattered radiation and move system with joystick
  • doesnt need second xray tube for projection radiography (theres bucky under the table)
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17
Q

lastly why was a c arm system invented/ benefits it provides

A
  • has all the benefits of a remote system
  • many of the benefits of interventional room where instead of turning the patient, you turn the system
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18
Q

what are the 2 main issues with c arm system

A
  • needs dedicated fluroscopy room
  • not designed for plain radiography use
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19
Q

which of the 3 fluoroscopic systems is used for angiography

A

c arm

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20
Q

why is the c arm used for angiography / what benefits does it provide

A
  • outstanding image quality to demonstrate small vessels and guidewares
  • fast frame rates, minimal dose to patient and operator
  • functions for long time without over heating

-

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21
Q

what body compartment is most demanding for fluroscopy

A

cardiology

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22
Q

be aware that cardiology is the most demanding fluroscopy with the highest dose risk

A
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23
Q

what are the 6 body systems scanned using R&F

A
  • upper and lower gastro intestinal tract
  • urinary system
  • genito-urinary system and gynaecology
  • billiary system with endoscope
  • joints
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24
Q

what is a defecography/proctogram and what is it used for

A

examination of the lower bowel and rectum using x-rays

  • for rectal incontinence
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25
Q

what contrast is used for fluroscopy of GI tract

A

barium (meal/swallow or enema)

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26
Q

what is an antegrade pyelogram

A

Antegrade pyelography is a diagnostic test that uses special contrast agent (dye) to produce detailed X-ray pictures of the upper urinary tract (kidney and ureter).

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27
Q

what is retrograde pyelogram

A

uses special contrast agent (dye) to produce detailed X-ray pictures of the ureters and kidneys.

  • The difference is that in retrograde pyelography the dye is injected directly into the ureters rather than into a vein. It is better suited to see the definition of the upper urinary tract, particularly the ureter and kidney
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28
Q

what is antegrade pyelogram used for

A

to assess obstruction, insert shunts

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29
Q

what is retrograde pyelogram used for

A

haematuria, stone removal

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30
Q

what is a urethrogram and what is it used to assess

A
  • xray imaging to asses structure of urethers
  • used to see if there are strictures
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31
Q

what is hysteria-salpingogram

A

utilizes radiopaque dye injected into the uterus and is visualized with an x-ray.

  • assess patency of Fallopian tubes
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32
Q

what is micturating/ voiding cystogram and what is it used to assess

A
  • uses contrast to image urinary system
  • used to identify UTI or incontinece
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33
Q

why do all the R&F systems have tilting tables

A
  • need to move patient around on motor controlled top
  • air and liquids. might be used to coat and outline the anatomy
  • may ask patient to do things which are easier not supine
34
Q

what are 2 common table tilts/ table positioning in R&F

A
  • standard angulation 90 degree
  • 30 trendelenburgh (head down)
35
Q

what are the standard weight limitations on R&F table

A

150-240kg

36
Q

how many focal spots does a R&F x-ray tube have

A

2

37
Q

what main characteristics must the anode in an R&F have

A
  • high anode heat capacity
38
Q

what material filtration should a R&F xray tube have

A

copper

39
Q

what material insert does the xray tube in R&F have

A

ceramic

40
Q

an R&F xray tube has a gridded tube, what is this

A
  • electrostatic ‘grid’ that holds the electrons close to the cathode, acting like a switch so they can be pulsed
41
Q

what type of anode does the R&F xray tube have

A
  • heavy, combination anode
42
Q

what do all the features of an R&F xray tube allow/ benefit

A

all factors/ component of R&F xray tube contribute to not overheating and shutting the system down

43
Q

what are the 2 types of anti-scatter grids used in R&F

A
  • oscillating
  • fixed grid
44
Q

where would u find the grid in under couch, over couch or c arm

A

under couch = in screening carriage

over couch = in bucky under table

c-arm = static, fixed but removable grid in front of image receptor

45
Q

why is a grid needed in fluroscopy

A
  • you are usually imaging thick body parts at 80kV+ so lots of scattered radiation both backwards from patient and towards image receptor
46
Q

a medical LED display monitor is the system used in R&F, what are the pros associated with this sytem

A
  • short response time
  • high definition (large pixel range)
47
Q

the imaging storage system for R&F is short term, what does this mean

A
  • enough space for 1-3 months
  • need to archive onto PACS
48
Q

what does PACS stand for and what is it

A
  • picture archiving and communication system
  • a computerised means of replacing the roles of conventional radiological film: images are acquired, stored, transmitted, and displayed digitally.
49
Q

how does an R&F system using an image intensifier (traditional way) work

A
  1. xrays strike input phosphor (caesium iodide)
  2. phosphor glows
  3. light picked up by photocathode and turned into electrons
  4. electrons accelerated up image intensifier by high kV (increase in energy)
  5. magnetic field focuses electrons
  6. electrodes intensify energy more by focussing it on small output phosphor
  7. output phosphor (ZnCdS) glows
  8. light captured by CCD (charged couple device)
50
Q

what material is the output and input phosphor in image intensifier

A

input = caesium iodide
output = zinc cadmium sulphide

51
Q

what is image intensification gain

A

by how much does the image intensifier, intensify the image

52
Q

define flux gain (FG)

A

increase in number of photons from output phosphor compared with input phosphor

53
Q

what is the approx value of increase in number of output compared to input phosphor

A

x50 to x100

54
Q

define minification gain (MG)

A

diameter of output compared to input

55
Q

how do you calculate brightness gain

A

flux gain x magnification gain

56
Q

what is the range of modern amplification

A

x5000 to x9000

57
Q

find image of image intensifier component and label and state what each thing does

A
58
Q

find image of R&F xray tube and label each thing and state what each thing does

A
59
Q

what is the typical diameter of a circular field of view

A

32cm

60
Q

what is the diameter of circular field of view for small or larger size

A

large = 38-40cm
small = 23cm

61
Q

explain how an image is magnified on R&F system + the consequences related

A
  • smaller central area on input phosphor is focussed onto the same output phosphor
  • causes loss of brightness and increase in noise from smaller FOV
62
Q

how would you regain signal to noise ration due to image magnification

A

double the dose (approx) to compensate and maintain same image quality

63
Q

what is the relation between FOV and dose and image quality

A

the smaller the FOV, the higher the dose to maintain image quality

64
Q

what is seen differently on live fluoroscopic image and acquired recorded imaged

A
  • on live fluroscopy the image is reversed black and white (air is white and density is dark)
65
Q

what are the standard pixel size of images on any fluoroscopic system

A

1024 x 1024 pixels, 8 bits

66
Q

what is pre-set LUT

A
  • lookup table
  • preset that can adjust a much wider range of image parameters, things like exposure, sharpening and vignetting.

A preset can contain a LUT, but a LUT is not generally referred to as a preset.28 N

67
Q

what is ABC and why do we need it

A
  • automatic brightness control
  • amount of light reaching output phosphor is adapted so image doesnt become too birght or dark and with adequate penetration
68
Q

automatic brightness control is automatic, what function controls this and how does this adapt depending on the body part being screened

A

it is controlled from a sensing window in centre of image (red box seen)

  • the shape and size of the sensing window should be set to match the anatomy expected for the preset protocol
69
Q

what is FLARE artefact in fluroscopy and what causes it

A
  • extraneous light around anatomy seen from raw radiation striking the input phosphor and gets included in sensor calculations
  • Caused by a transition from heavy attenuation to minimal attenuation.
70
Q

how does automatic brightness control work in practice (what 2 physical factors are adjusted for brightness control if not using ABC)

A
  • POSITIONING
  • COLLIMATION
71
Q

how does positioning and collimation affect image quality in fluroscopy

A
  • positioning and collimation controls the light
  • the dose is then controlled
  • which controls the brightness
  • and positively or negatively impacts image quality
72
Q

be aware that you must know how the system works to be able to optimise the images

e.g u see sensing window is too large which will make image too bright and cause insufficient penetration

A
73
Q

how can too much flare and anatomy within the image affect the image quality

A
  • becomes dark and noisy as the exposure and gain are reduced
74
Q

how is the image quality affected if there is too much dense barium-filled, bones, metallic implants or heart

A
  • image becomes over bright and saturated
75
Q

what is AGC and why is it used

A
  • automatic gain control
  • when light intensity within image drops, system can automatically increase electronic signal (GAIN) to compensate without increasing xray dose
76
Q

in practical terms, AGC can maintain the signal of a movie object whilst giving time for the ABC to react

A
77
Q

what practical issues are there with the physics of the image intensifier

A
  1. has a curved surface which distorts the image (pin-cushion effect)
  2. edges of image are long way from source so fade
  3. image is intensified using electrons and magnets which susceptible to earths magnetic field
  4. image made with light and when here’s less light you must increase radiation dose to compensate
78
Q

what is the difference in dosage for a general view and a diagnostic view in fluroscopy

A

low dose per Fram for general view

higher dose, higher quality images for diagnosis and archiving

79
Q

what are the 2 types of imaging in fluroscopy and the difference between them

A
  • fluroscopy (screening) (lower dose)
  • fluorography (acquisition/record images) (higher dose)
80
Q

how much higher is the dose for fluorography (acquisition image) than fluroscopy (screening

A

x5 to x10

81
Q

what are 3 types of image capturing done on fluroscopy system

what are the difference between them

A
  1. fluoroscopic screen captures (can store fluroimage currently on screen)
  2. last image hold
  3. fluorography ( 1 acquired image at a time or a sequence)
82
Q
A

RAD413 (24 decks)

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