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X-Rays and Fluoroscopy: J.Lisý

X-rays and fluoroscopy provide images of internal body structures. X-rays are produced when high-energy electrons collide with a metal target in an X-ray tube. X-rays can be used to generate static images or real-time fluoroscopic images. Factors like voltage, current, and exposure time influence image quality and radiation dose. Shielding, time, distance, and amount principles help minimize radiation exposure. Common medical uses include imaging bones, lungs, gastrointestinal and urinary systems, and guiding procedures like angiography and surgery.

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89 views34 pages

X-Rays and Fluoroscopy: J.Lisý

X-rays and fluoroscopy provide images of internal body structures. X-rays are produced when high-energy electrons collide with a metal target in an X-ray tube. X-rays can be used to generate static images or real-time fluoroscopic images. Factors like voltage, current, and exposure time influence image quality and radiation dose. Shielding, time, distance, and amount principles help minimize radiation exposure. Common medical uses include imaging bones, lungs, gastrointestinal and urinary systems, and guiding procedures like angiography and surgery.

Uploaded by

ksjanarthanan_sri
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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X-rays and fluoroscopy

J.Lisý
Wilhelm Conrad Röntgen 1845-1923
• 8.11.1895 Würzburg, Germany
• 1901 the first Nobel prize in physics
On a New Kind of Rays
• A discharge from a large induction coil is
passed through a Hittorfs vacuum tube
• The tube is surrounded by shield of black
paper
• in a completely darkened room
• paper covered on one side with barium
platino-cyanide lights up with brilliant
fluorescence when brought into the
neighbourhood of the tube
Electromagnetic waves

forms of electromagnetic waves


(wave length + frequency)

•Gamma rays
•X- rays
•Ultraviolet
•Visible
•Infrater
•Radio waves
X ray tube
• a vacuum tube
• uses a high voltage to accelerate electrons released by a
hot cathode to a high velocity
• the high velocity electrons collide with the anode, creating
the X-rays
Influence of physical parameters
• intensity elecric current mAs quantity of X ray
• tension, voltage KV (50-100) quality of X ray
Soft X ray technique
• tension less than 50 KV
• longer wave length
• photons of X-ray beam absorbed by
superficial tissue
• increased radiation dose

• mammography
Hard X-ray technique
• tension above 100 KV
• shorter wave length
• photons of X-ray beam have higher energy,
less absorbed
• decreased radiation dose (like in CT)
Features
• Straightforward spread of photons
• Absorbed by tissue
• Diferent absorption of X- ray beam
(increased atomic number … increased
absorption)
Adverse effects
• Non stochastic deterministic
treshold dependent
(X ray burns, dermatitis, sarcomas)

• stochastic
treshold independent
(genetic mutations)
Protection against adverse effects

• Dosimeter (evaluated every month)


• lead vest (1 mm Pb)
• barium within walls (3,5 cm barium
sulphate)

• shutters
• dose decreases with square of distance
ALARA (As Low As Reasonably Achievable)

potential risks from a procedure be carefully balanced with


the benefits of the procedure for the patient

•Shielding use proper barriers to block or reduce ionizing


radiation
•Time spend less time in radiation field
•Distance increase distance between radioactive sources
and workers or population
•Amount reduce the quantity of radioactive material for
a practice
Radiation dose
• Radiation dose from natural radioactive
sources
equals 2,3 mSv/year

• 115 lung X-rays


• 1 brain CT
X-ray terminology
• Negative
(photographic film,
not photo itself)

• White - shadow
increased attenuation
• Black - lucency
• decreased attenuation
Development of X-ray image
• developer
• water
• fixative
• water
• drying procedure

• AgBr
Digital radiography
• film less X ray cassette

• RTG sensitive layer of crystals

• negative electric charge

• after exposiotion negative charge is canceled

• laser is used to read charge on crystal


Digital radiography
DR digital radiography direct digitalisation
(detector in mobile
X-ray equipment)

CR computed radiography undirect


(film less cassette)
X-ray projections
• Antero-posterior A-P and postero-anterior
P-A (to X-ray tube)
• Lateral and oblique (to cassette)

Right posterior oblique (R shoulder and back


to cassette)
X-ray report
• 1 identification (name, ID, dept)
• 2 date (site sign R/L)

• 3 normal x abnormal
• 4 conclusion
differential diagnosis
recommendation of further imaging (CT more
sensitive for lung metastasis than X- rays)
X-ray image of lung

normal venous congestion


Positional influence X-ray lung

fluidothorax upright fluidothorax supine


Fluoroscopy
• X-ray in real time

• C arm, U arm,Fluoroscope

1. an X ray source
2. fluorescent screen
i.e. X ray image intensifier
Image intensifier
Electro-optic convertor
•primary input screen (large area) photon turns into electron
•dinodes ( multiplication of electrons)
•secondary output screen (small area) electron into photon
•increases brightness of image (dose reduction)
Image intesifier
the output image is approximately
105 times brighter than the input
image. This brightness gain
comprises a
• flux gain (amplification of photon
number)
• minification gain (concentration
of photons from a large input
screen onto a small output screen)
Contrast media
• positive barium sulphate
iodine water soluble c.m.(1 ml/kg)

• negative air, CO2


Flat-panel detectors

• increased sensitivity to X-rays, potential to


reduce patient radiation dose
• temporal resolution is also improved over
image intensifiers, reducing motion blurring
Fluorocopic examinations Upper GIT

• p.o. swallow of CM
till duodenum
• per rectum irrigography
till terminal ileum

single contrast
contrast fill lumen
Single x double contrast

single contrast double contrast


• contrast fill lumen • mucosal relief
Double contrast - Lower GIT
• Mucosa (barium + air)
Enteroclysis (duodenal tube, barium + methylcelulose)
Uro/genital tract
• micturating cystourethrogram (MCUG)

• retrograde pyelography

• hysterosalpingograpphy
Angiography
• Arteries
• veins
Orthopaedic surgery to guide fracture reduction and
the placement of metalwork
Placement of peripherally inserted central venous
catheters, pacemaker
Voiding urography
Upper urinary pathways
(dynamic proces,
but without fluoroscopic control)

• native (urinary stones)


• i.v. iodine CM (1ml/kg) cubital vein
• 3 X-ray in time delay
(7 min,15 min,30 min)

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