Sammy Puccini

Notebook 10
Date Occurrence
1895 Rontgen discovers x-rays
1896 3/3: damage to eyes from
Edison created fluoroscope 4/18: skin effects first noted
July: 1st x-ray protective device-
heavy glass plate to protect eyes
1898 January: Aluminum filter used as
protective device
July: Collimators
1899 Listing of protective devices
1901 X-ray lethality to people alleged
1904 First death in x-ray
1907 Mutation by x-ray in toads
1912 Half value layer concept
1920 First x-ray protection committee
1922 Film badges for personnel
monitoring
1927 Genetic affect of x-ray shown
1937 Irving Langmuir patented image
intensifier
1948 J.W Coltman improved design so
image brightness increased
1953 Westinghouse manufactured first
commercial use image intensifier

In a narrative, list and describe the terminology of basic visual

physiology and determine its importance in radiology image
illumination.

Rods and cones are embedded in the retina, the iris controls the amount of
light coming into the retina.

Phototopic = daylight (cones)

Scotopic = nighttime (rods)

Rods are sensitive to low light, they cant respond to intense light (2 lux); the
rods view dim objects peripherally.
Cones are less sensitive, they can respond to intense light (100 lux). X-rays
displayed at 100-1000 lux. Cones are where color and visual acuity are
formed, and can see variations in densities (contrast)
The goal for better image diagnosis is to have cones activated, so image
brightness needed to increase.
Sammy Puccini
Notebook 10
Lesson 2

Part A: Fluoroscopy Equipment Diagram:

Using the provided graphing templates, create a diagram of a fixed
and mobile fluoroscopy unit. Label with correct terminology.

Part B: List all the components of mobile and fixed fluoroscopy, add
a brief description of its function or purpose.
Sammy Puccini
Notebook 10
Image intensifier: has a negative cathode and positive anode, input
window and phosphor layer, electrostatic lenses, phosphor layer and output
window, protective housing and shielding
X-ray tube: high heat capability, low mA settings 0.5-5.0
Monitor: simple television devices used to record and view video. Through an
optical lens coupling or fiber optics
Optical coupling: can occur at the output screen to a charge coupled
device, or fiber optic system. Then this goes to an analog to digital converter.
Some systems split the image
Grid: range from 6:1 to 10:1, can be removed, air gap can be a substitute by
raising the carriage
Table: need to be radiolucent, normally carbon fiber material
Filtration: The use of 2.5mm aluminum equivalent still applies to fluoro, this
includes all added filtration such as tabletop
Collimator: reduce scatter and improve visualization of detail through
improved contrast resolution. They are automatic and restricted to the field
of view. There are rectangular ones that can be used manually to limit the
field size.
C-arm: supports tube and image receptor, keeps them aligned

Part C: Describe the flow of electrons in a narrative or with bulleted

statements beginning at the source through the image intensifier.

-Primary x-ray beam exits the patient and strikes the input screen of the
image intensifier.
-This fluorescent screen absorbs the x-ray photons and emits light photons.
-These light photons encounter the photocathode, which absorbs the light
photons and emits -electrons.
-The electrons are accelerated from the cathode toward the anode and the
output screen.
-At the same time, the electron beam is focused onto the output screen,
which is smaller than the input.
-Electrons are accelerated and focused, which intensifies the image into a
smaller area.
-The output screen absorbs the electrons and emits light photons.
Sammy Puccini
Notebook 10

Lesson 3
1. While using a image intensifier with a 10/7/5 diameters, which
size is best for contrast resolution and why? Which one is best
for spatial resolution and why? Which one has the largest field
of view?
Contrast resolution: small diameter to increase magnification
Spatial: smallest- 5 because more focused and more detail

2. Describe minification gain and the relationship with increasing

input phosphor size, kVp, mA, output phosphor size, and tube
voltage.

Minification gain= input screen diameter^2/ output screen diameter^2

Minificaiton gain is taking the same number of electrons that are emitted at
the photocathode (large diameter size) and using them to create the image
at the smaller output screen

3. Describe what occurs when the image intensifier is operated in

the magnification mode as it relates to contrast resolution,
spatial resolution, patient dose, the relationship of the focal
point between the input phosphor and the output phosphor.
Focal- large input gives a small output
Contrast- more patient dose, wide window, more density
Spatial- small diameter= less spatial resolution= magnification

Equations used in fluoroscopy :

Flux gain = number of output light photons
Number of input x-ray photons

Brightness gain = Minification gain x Flux gain or use the conversion

factor equation.

Minification on gain = (dinput)2

(doutput)2

Conversion factor = output phosphor illumination (cd/m2)

Input exposure rate (mGya/sec.)

Magnification factor = mode 2 in multifield Image Intensifier

Mode 1
Sammy Puccini
Notebook 10
New ESD = Original input screen size X Entrance Skin Dose
New input screen size

4. What is the brightness gain for a 17- cm image intensifier tube

with a flux gain of 120 and a 2.5 cm output phosphor?
17^2/ 2.5^2 = 289/6.25 = 46.24x120 = 5,548
5. A 23/15/10 image intensifier is used in the 10cm mode. How
much higher is the patient dose using this mode compared to
using the 23 cm mode?

Principal: when using the magnification mode, the minification gain is

reduced, so fewer photoelectrons are hitting the output phosphor. This
creates a dimmer image. To compensate for the magnification mode
(maintain the same amount of brightness), the tube mA is increased.
The increase in dose to the patient when changing from 23 cm to 10
cm is equal to the ratio of the input phosphor diameter to the
diameter used in magnification mode.

23cm^2/10cm^2 = 529/100 = 5.29

6. What is the change in dose (how much higher) when switching

from a 23cm FOV to a 17cm FOV?
Use same principal as in question 5
23cm^2/17cm^2 = 1.83

7. A photofluoroscopic image is obtaining using the technical

factors of 80 kVp in the 15cm mode without a grid. He
measured entrance skin dose (ESD) is 0.5 mGyt. What ESD
would be expected if the 25cm mode were used?
Original input screen size X ESD = New ESD
New input screen size

15/25 x .5 = .3

8. A 23cm image intensifier has an output phosphor size of 2.5cm

and a flux gain of 75. What is the brightness gain?

23^2/25^2 = 529/ 6.25 = 84.64 x 75 = 6,348

9. Create a scenario using one of the equations above with the

specific factors required. Be sure to show your work and
include the answer.
Sammy Puccini
Notebook 10
What is the minification gain for an image intensification tube with an input
screen diameter of 20 cm and an output diameter of 5 cm?
20^2/5^2 = 400/25 = 16

Lesson 5
Create a chart using the Table below to compare Digital Fluoroscopy
Equipment and Image Intensified Fluoroscopic Equipment. Include
information related to patient dose, contrast resolution, spatial
resolution, size of the component, distortion, tube mAs.

Digital Fluoroscopy Equipment Image Intensified Equipment

Components Components
Flat panel and/or CCD Image intensifier
Faster speed to acquire images Computer between intensifier and
viewing monitor
Post-processing of images to Camera tube that split signal
enhance edges, called image between recording system and
subtraction viewing monitor
Multiple monitors
Can remotely control the imaging
system
Flat detector with maintained spatial Curved input phosphor leading to
resolution in periphery peripheral field of view distortion
Highly sensitive x-ray detector x-ray detectors not sensitive
Large dynamic range of x-ray Small dynamic range of x-rays
detected detected
Magnification requires less x-ray Magnification requires higher x-ray
exposure exposure, which means more dose
to the patient
Digital technology System developed using analog
technology

Less radiation; less dose to the

patient because it is delayed,
because it wont terminate exposure
Dynamic range of number of
photons detected is greater
Greater spatial resolution

Lab: Describe how the image changes as FOV changed phantom to

a thin portion. Include noise, technical factors.
There was less noise when thin body parts were imaged.
Technical factors also decreased on thinner body parts.
Sammy Puccini
Notebook 10
Thin body parts created a low OID and increased contrast, and reduced
magnification
Brightness varied as technical factors varied to compensate for
different FOVs.
Frame/sec dose decreases unless a higher mA is used, zoom focal spot the
FOV is compressed = increased detail
When applying technique were narrowing the beam, x-ray beam is
being compressed

How ABS works

ABS changes brightness as the anatomic location is changed, lag occurs
The mA changed as the part thickness changed during ABS, technical factors
increased as brightness increased. The increased technique raises the
patient dose

The films in lab showed that the cassette 3 feet away from the C-arm showed
the bar it was leaning on, on the image. And 6 feet away the film had scatter
from the C-arm.