1. Fluoroscopy Static Image Recording Systems
Based on:
Principles of Radiographic Imaging, 3rd Ed.
By: R. Carlton & A. Adler
Radiologic Science for Technologists, 8th Ed.
By: S. Bushong
Syllabus on Fluoroscopy Radiation Protection, 6th Rev.
By: Radiologic Health Branch – Certification Unit
PPT created by: Jed Miles, BSRS, RT(R), CRT-CA

2. Static Recording Systems
Static images are necessary when a permanent record of the fluoroscopic examination is required
Static recording is done using:
Video discs
Spot film cameras
Conventional cassettes
Digital fluorography

3. Video Disc Recording Video disc recorders used to record
Single field
Single frame
Short sequence
Last image hold / freeze or “sticky fluoroscopy”
Electronic radiography
Frame rates or speeds vary from 1 image per sec to 30 images per second
Both magnetic and laser video disc equipment is available for either digital or analog recording

4. Spot Filming
Spot filming can be performed in a manner that functions as a single image or a series of images simulating a dynamic recording (serial spot films)
Spot filming is accomplished using:
100 or 105 mm chip film (cut film, sheet film)
70 or 100 mm roll film (long roll of film)
Cassettes (film/screen & imaging plate)

5. Spot Filming - Roll, Chip, Cut or Sheet film
Photo spot or spot film cameras photograph image on output phosphor of image intensifier
Typically use much higher mA with short exposure time to acquire image as compared to simple fluoroscopy
20 – 50 times higher dose per frame than fluoro
Still a substantial dose reduction compared to cassette spot film (about 50% reduction per image)
If serial photospots are taken – dose will increase
Photo spot camera close in design to cine camera
Functionally much slower
Like sheet film used in conventional radiography, cut and roll film requires wet chemical processing

6. 105 mm Roll Film Camera TV Camera 70mm camera
70mm camera supply and take-up magazine
70mm camera
Light distribution center
Image intensifier
Camera removed from light distribution center of image intensifier

7. UGI Series using 105 mm roll film
105 mm Roll Film Camera
Roll film supply magazine removed from photospot camera
Roll film removed from supply magazine
UGI Series using 105 mm roll film
Images are cut into strips of 4 and laminated together for ease of handling

8. 105 mm Roll film showing UGI and BE Photospot images
An optical “Overframe” method was used to project the image onto the film

9. Chip or Sheet Film Changers
Chip film changers use individual sheets of 100 or 105 mm film contained in a magazine
Operationally the camera works nearly identical to a roll film changer, with the exception of a mechanical device to handle sheet film
An exposed film receiver stores the images prior to wet chemical film processing of individual sheets

10. Cassette Spot Filming Uses standard radiographic cassettes
Utilizes remnant (pre-intensified) exiting radiation from patient
Standard sizes include:
9” x 9” (24 x 24 cm)
8” x 10” (18 x 24 cm)
10” x 12” (24 x 30 cm)
Other spot film changers will take 11”x14” and 14”x17

11. Cassette Recording – How it Works
Cassette stored in lead-lined compartment in fluoro carriage
Controls on fluoro carriage initiate mechanism for spot film exposure
Cassette transported to intercept primary transmitted x-ray beam
X-ray tube current boosted to ,200 mA
Carriage controls permit selection of different areas of cassette to be exposed
1on1, 2on1, 3on1, 4on1 etc
Collimator shutters AND spot film mask shutters automatically mask to desired area of exposure
Cassette auto centered onarea to be exposed

12. Cassette Recording – How it Works
After exposure is initiated, AEC terminates exposure at set density
Cassette is returned to “park” position in storage compartment
Cassette spot filming causes single highest dose rate of all fluoro recording mediums
May require up to 300µR per exposure at the cassette
Translates into over 30 mR entrance skin exposure (ESE)
Estimated that each spot film may be equal to more than one minute of fluoroscopic time
Significant tendency to over-document negative findings in the U.S. due to malpractice litigation

13. Digital Fluoroscopy
Digital (computerized) fluoroscopy produces images using video camera and digital image processor
Image converted by analog-to-digital (ADC) converter
This step can be eliminated if using a digital video camera (CCD)
Digital data computer processed and stored in image processor memory
Image must be converted back to an analog image by a digital-to-analog (DAC) converter to view
Currently, PACS systems can be used for digital image storage

14. High Level or “Boost” Fluoroscopy
Refers to a “special activation” capability of certain fluoroscopy systems
Entrance dose rate to patient is 2-10 times greater than conventional fluoroscopy
Interventional radiology and cardiac procedures can be long and demanding
Extremely small guidewires and catheters must be visualized
Requires
High signal-to-noise ratio
Very low quantum mottle
May result in total patient dose rates exceeding several hundred rads

15. Key points Regarding Boost
1994: regulations passed that limit maximum tabletop dose rate to 20 rads per minute when acquiring images without recording devices being utilized
Special activation at the control panel is required with an additional person
Key and interlock must be activated
Audible signal must be heard in the room while high level or boost fluoroscopy is energized
Tabletop dose rate is limited to 20rads/min unless recording devices are used as of 1994

16. Just so you know… Department of Health and Human Services
Centers for disease and Control and Prevention
Cutaneous Radiation Injury: Fact Sheet for Physicians
Acute Radiation Syndrome: Fact Sheet for Physicians

17. What’s Next?
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