Fluoroscope

 INTRODUCTION 

What is Fluoroscopy?

Fluoroscopy is a medical imaging procedure that uses an x-ray beam that goes continuously through the body to make an image and it is also a sort of x-ray that displays organs, tissues, or other interior structures moving in real-time. The image is projected on a monitor, allowing the doctor to watch the inside organs move in real-time.

Fluoroscopy is used to aid in the diagnosis of abnormalities with your,

1. Esophagus

2. Stomach 

3. Duodenum

4. Small bowels

Doctors can use this approach to see the flow of oral contrast through the digestive system in real-time.

The fluoroscopy examination will scan your,

1. Upper GI

2. Small bowel

Inform the nurse or technologist if you are allergic to any medications or if you have recently undergone a high-density contrast procedure. You may take your normal medication with modest amounts of water the day before and after the exam. The stomach and small intestine will be shown in the small bowel series. You should not undergo any contrast studies within 24 to 48 hours of this exam.

Fluoroscopy Machine:

 

An endless stream of x-ray images. Around 25-30 images per second. Images are shown on a computer monitor. Similar to a television screen.

HISTORY OF FLUOROSCOPY.

Roentgen's X-Ray: 

1895 Thomas Edison exposed over 8000 chemicals four months later. Calcium tungstate has the most fluorescence and was used to make the Edison Vitascope (device for recreational Fluoroscopy). After the death of his assistant, Thomas never returned to X-Ray research. He examined his hand with a custom-made fluoroscope. Clarence Dally, his aide, died as a result of radiation. 

Early fluoroscopes were basically cardboard funnels, open at the narrow end of the observer and closed with a skinny cardboard piece coated on the inside with a film of fluorescent metal salt. The fluorescent screen produces only a small limited light. The fluoroscope image was faint, so the radiologist went into the darkroom to adjust their eyes to the darkness. William Trendelenburg created red adaptation goggles. 

Russel H. Morgan invented the image intensification tube in the 1940s. Image visibility is improved, the radiation dose is reduced, and a persistent image is recorded out of light.

How It Works?

The machine utilized in fluoroscopy is called fluoroscope. The fluoroscope is a sort of x-beam machine that can either utilize a beating or steady x-beam bar. The x-beam machine has an x-beam tube that is either made of glass or metal and has a vacuum seal inside. It produces an x-beam by changing over power from its electrical cable. The electrical cable has a flow of 120-480 volts, anyway it should be changed over into a 25-150 kilovolt range. 

Then, at that point, it creates a current of electrons that are taken shots at a tungsten target. At the point when the electrons strike this objective, the electrons stop and make the arrival of the body being imaged. These electromagnetic waves can go through the body and make images of the inside structures. Various tissues in the body have various densities; along these lines, the tissues that are less thick ingest less of the x-beam. 

The diverse in the measure of waves being assimilated is the thing that makes a distinction in the openness and permits the image to be more definite. With the fluoroscope, when the pillar goes through the body, it hits an image intensifier, which builds the splendor of the picture, so it very well may be seen on a presentation screen. 

The picture intensifier likewise contains a camcorder that catches the two-dimensional examples of light as a video from the x-beam machine. Then, at that point, the sign is changed over once more into an example of light, which can be seen on the screen, as an image Illustrate the parts of an analog fluoroscopy image intensifier tube.

There is an input phosphor there is a photocathode right behind the phosphor. Then there are series of electrostatic lenses that push electrons towards a focal point & this accelerating anode towards. Which the electrons are being attracted and finally there is an output phosphor. 

So, what we are doing is we are converting the x- rays ate coming into the fluoroscopy. They are hitting this input phosphor and the input phosphor is glowing. It's giving off light x- rays hit the phosphor and the glow right. Then this photo Catherine picks up the light and turns that into electrons. Right turns the light into electrons which are then accelerated towards this anode. 

Very similar to what's happening inside of an x-ray tube right. We had the production of electrons they are accelerated towards an anode in this case. They are not going to strike the image instead. 

The Physics of Image Intensifier that which Used in Fluoroscopy:

Originally the conventional fluoroscopy way back when they didn't have a way to do that so the images that they were looking at were very dim and they had to use what are called rods in the eye & the rods see dim objects. They see black & whites and so the whole purpose of bringing the brightness up the brightness level up is to change the vision into the co vision which have they see much better & we'll get into a little bit more of that just a minute. So, a bottom line is they were developed to increase the brightness & they increase it a great deal 

We are just increasing the brightness exponentially over the original image, this particular image shows us the entire system, and also on the side, you're going to see an eye - without casing on its side.

The eye itself and in this particular image, you can see the x-ray tube below the table. The beam interacting with the patient & the remnant beam coming into the image intensifier itself. 

The remnant beam radiation coming from the patient interacts with the input phosphor and at the input phosphor radiation. The information it carries is changed into light photons and then the light photons hit the photocathode where they're changed into electrons & they are accelerated at a very high speed as well as being compressed by the electrostatic lenses which are following the size of the periphery of the image intensifier tube. 

They come to a focal point and at that point, they actually cross over, and then they come out of a very small output phosphor it's about one inch. You have a very large curve for the input phosphor & the very small output phosphor. 

This whole process is what gives us that extreme brightness that we have in our image and then once it comes out of the output phosphor there are some things that happen to it.

Flux Gain: Measurement of the input light photons due to the conversion efficiency of the output screen.

Brightness = Flux Gain X Magnification Gain

Fluoroscopy Quality Control:

Exposure rate:-

• Normal fluoro: ESE < 10 R / Min 
• Interventional fluoro: ESE < 20 R / Min
• Cineradiography: Unlimited exposure rates. 

Spot film exposure:-

• Cassette ESE approximately 200mR per spot.
• Photo fluoro spot ESE approximately 100mR per spot.

Automatic brightness control (ABC):-

• Evaluate annually. 

Patient dose during fluoro: Conventional vs Digital 

Patient dose	Conventional	Digital
5-minute fluoro	200mGy (20 rad)	100mGy (10 rad)
3 spot films - normal mode	6mGy (0.6 rad)	2mGy (0.2 rad)
3 spot films – mag mode	10mGy (1.0 rad)	3mGy (0.3 rad)
Total Dose	216mGy (2.16 rad)	105mGy (10.5 rad)

Image Intensification

Input phosphor:

• Mad of cesium iodide (CsI)
• Receives radiation exiting patient. 
• Emits light photons.

Photocathode:

• Responds to the light exiting input phosphor. 
• Emits electrons. 

Electrostatic lenses:

• Focus electrons. 

Output phosphor:

• Receives electrons from the photocathode. 
• Emits 50 – 75 × more than received by the photocathode

Distortion.

As the size of the input phosphor is usually very large as the size of the input phosphor is increased or decreased. You're increasing and decreasing just the Distortions. If you have left it wide open say 25cm is your largest size if you leave it at 25. You will see in your image is quite a bit of distortion in the periphery.

1. Pincushion distortion:

    Caused by projecting an image formed on a curved input phosphor to a flat output phosphor.

2. Vignetting:

    Decrease in brightness or light intensity- periphery of the image.

3. Veiling Clare:

•     Scattered light in the output window 
•     Increase your background signal &it decreases the actual contrast of your image. 

Charge Couple Device:- 

Advantage of the charge-coupled device for medical imaging. 

• High spatial resolution. 
• High signal to noise ratio. 
• High detective quantum efficiency (DQE).
• No warm-up is required. 
• No leg or blooming. 
• Lower patient dos. 
• Unlimited life. 
• No spatial distortion. 

Creating a Fluoroscopy Image:-

The amount of radiation required varies and it’s based on the procedure. A necessary characteristic of Fluoroscopy is sensitivity. Amount of exposure needed to form an image. Non-intensified Fluoroscopy utilizes a fluorescent screen only just for a receptor. Key facts

• Generally real-time exams

• Typically uses an under-table tube and radiation is shooting upward

• Exam dependent
• May needs the use of contrast media 
• X-ray altering media that either positively or negatively affects the image counting on what is used to make something stand.

• X-ray tube & imaging device mounted on C-arms to keep up SID

PROCEDURE OF FLUOROSCOPY 

What happens during a fluoroscopy procedure?

• We will be asked to remove any clothing or jewelry that may interfere with the procedure, and depending on the type of procedure, we may be asked to: assume different positions, move a specific body part, or hold our breath at intervals while the fluoroscopy is performed.

• A special x-ray machine will produce fluoroscopy views of the body structure being examined or treated.

CONTRAST PROCEDURE

• During the test, you will be asked to change into scrubs or a hospital gown. Your personal item will be secured in a looker you will stand between a table and a fluoroscopy machine. 

• You will drink contrast medium. You will be asked to turn in different positions. This will allow the camera to take images of your abdomen from all angles. 

• Multiple peeping sounds can be heard during the exam.
• Upper GI exams will take approximately 30 minutes. 
• Small bowel series exams will take 1 to 4 hours longer. 

• After the test, you will be discharged. Immediately after the exam, there are no driving restrictions. Drink at least 6 to 8 ounces of fluids preferably water. You may eat a regular diet include Fiber unless otherwise instructed to do so by your doctor. There is no radiation to concerned with your doctors will discuss the results with you at your next appointment 

Barium X-Rays procedure 

• Fluoroscopy used alone.
• Give the physician the opportunity to check movement in the intestines.
• Barium moves through them during the procedure.
• Aids physicians in inserting a catheter.
• Likewise helps them in identifying blockages in arteries.
• Physicians can see the flow of blood.

Overall Procedure of Fluoroscopy

• Inclusion of an IV into the patient’s arm or hand.
• The patient moved onto the X-Ray table.
• Additional lines could also be inserted for catheter procedures.
• X-Ray scanner helps to make Fluoroscopic images of the body.
• Dye could also be injected into the IV at this point.
• The type of care is going to be selected after the procedure has finished.

What is it used for:-

Fluoroscopy and other medical imaging procedures serve an important role in avoiding health problems and identifying diseases. Our doctor may request that we undergo fluoroscopy during a hospital stay or outpatient procedure to determine treatment options for a specific health condition.

Fluoroscopy is a technique that is utilized in a variety of imaging treatments. The following are some of the most prevalent fluoroscopy applications:

• Barium swallow or Barium enema:- Fluoroscopy is used to show the movement of the gastrointestinal (digestive) system during various procedures. 

• Cardiac catheterization:- Fluoroscopy is used to visualize blood flow through the arteries, during this treatment. It's used to diagnose and treat some heart problems. 

• Placement of catheter or stent inside the body:- Catheters are hollow, thin tubes. They are used to get fluids into the body or to remove excess fluids. Stents are medical devices that help unblocked blocked or narrowed blood arteries. Fluoroscopy is used to check that these devices are properly placed. 

• Hysterosalpingogram:- Fluoroscopy is utilized to produce a view of a woman's reproductive organs in this operation. 

• Guidance is orthopedic surgery:- A surgeon may utilize fluoroscopy to aid in the guidance of surgeries such as joint replacement and fracture repair. 

• Electrophysiologic procedure:- The doctor employs fluoroscopy to treat patients with abnormal heartbeats during an Electrophysiologic procedure. 

• Arthrography:-  An X-ray is used to examine one or more joints. Catheter arthrography is one of the most common applications of chest fluoroscopy nowadays. 

• Percutaneous kyphoplasty or vertebroplasty:- The method is used by a specialist to treat spinal vertebrae fractures. 

• Needle or trans bronchial biopsies:- This procedure is used by a clinician to get a sample of lung tissue. 

Fluoroscopy Risks.

Fluoroscopy uses X-Ray technology, we have some radiation exposure. So, there are some minor risks associated with fluoroscopy. The amount we absorb varies and it depends on the procedure length and our size. 

There is always a slight danger of acquiring radiation-induced sensors regardless of how much radiation we are exposed to. Additionally, some people may experience radiation-induced harm to their skin, resulting in burns of their skin tissue. 

Furthermore, if we are pregnant or suspect we may be pregnant we should avoid having a fluoroscopy operation because radiation can affect an unborn child's body. 

However, if a fluoroscopy procedure is required, the benefits frequently outweigh the dangers. While the fluoroscopy procedure is not inherently uncomfortable. It may be painful at times. Some components of the test preparation, such as obtaining access to a vein or artery for angiography or injecting drugs into joints. 

In these circumstances, a technician is called upon measures that could be taken to make as more uncomfortable;

a) Conscious sedation. 

b) Local anesthesia.

c) General anesthesia. 

Trouble & Troubleshooting 

• If fluoroscopy doesn't measure anything of those parts first thing, we must check the power cable. because, if the main cable is disconnected or loosely connected, we can't see any parameters or any results from fluoroscopy. So, we must see the main cable with the machine and connect correctly. And then we can move next step. This is the main trouble and troubleshooting for all kinds of devices. 

• The second one is we must check the input voltage. Because, if we'll put the main cable in high voltage all systems will destroy. It is not a minor mistake it's a major mistake nowadays on the healthcare side. For example, if fluoroscopy’s input voltage is like 100V, so we must connect the machine input cable to a 100V power source. But if we didn't consider that's a thing, we can put cable regular source in our country standard 220 - 240V. So, this voltage is very over for machine. If we put it in this voltage supply the machine must damage out of our mind prediction. So, Technicians or Engineers must be known about machine input voltage and read service book of that machine & then move to installation or something. 

• Another thing is we can't see any movement by machine. So, we can check the main cable & the input voltage, if those things are correct, we should off the main power supply and be ready to troubleshoot the machine. So senior Engineers & Technicians are with their safety precautions. They should see the main part of the machine-like check the power board, motherboard, & processor from the senior Engineer's idea.

• Sometimes resistors, capacitors had disappeared so we can remove that and replace the same kind of things. If they won't find any damaged things, they must check the power board with multimeters like that. If they won't find trouble after that should inform the company of this particular machine and who does use this machine during treatment and then submit final reports to the company. 

These are the main procedures to find trouble and give the solution in the health care sector. 

The Above Article is Jointly Contributed By:-

• Juthindhara Madhavee Siriwardena - https://www.linkedin.com/in/juthindhara-siriwardena-467087220

• Muhammadhu Ihzan - https://www.linkedin.com/in/muhammadhu-ihzan-021a0a1a9

• Lakshana Kanagalingam - https://www.linkedin.com/in/lakshana-kanagalingam-9aa086220