1. Introduction to Fluoroscopy & Radiation Safety
RTEC Week 10
Rev 2010
References:
Merrills CH 16 & 17
Bushong – Ch 21

2. CONVENTIONAL FLUOROSCOPY INVENTED BY THOMAS EDISON
Early Fluoroscopy

3. Digital / Fluoro Equipment Check off
MUST BE COMPLETED PRIOR TO DOING ANY PATIENT EXAMS
Fluoroscopy Procedures must ALWAYS be supervised – even after a check off
You MUST be a CRT to have a Fluoroscopy Lic to operated fluoro units
in California (CDPH-RHB Title 17)

4. Fluoroscopy: Images in Motion Conventional & Digital Fluoro Principles
Fluoroscopy is a common technique used by clinical physicians to obtain real time images of moving body parts and internal structures of a patient compared to static radiographic examinations.

5. Objectives
Differentiate fluoroscopic examinations from static diagnostic radiographic examinations
Describe a typical basic fluoroscopic image chain (RT 244 – detailed)
Explain difference between fluoroscopic operation and a diagnostic x-ray tube
Safety Principles

6. Types of Equipment C-arm Under table/over table units
Conventional & Digital Units

7. Recording the Fluoroscopic Image
Cassettes
105 mm chip film
Digital fluoroscopy
Dynamic Systems
Cine film (cardiac cath)
Videotape (OPMS)

8. IMAGE INTENSIFICAITON photons are ampilfied + multiplied
IMAGES ARE VIEWED ON A
TV SCREEN/MONITOR

9. Image Intensifier & Cassette loading
Digital &
Conventional
Units

10. Image Intensifier
Bushong – Ch 21

11. Important to limit the field of view (collimation)

12. X-ray tube located under the table
Conventional Fluoro
X-ray tube located under the table

13. X-ray tube located under or over the table – remote controls
DIGITAL FLUORO
X-ray tube located under or over the table – remote controls

14. The Role of the Technologist
Provide Assistance
To the Patient
And Radiologist
Before, during and
after the procedure
Prep the room
Prep the contrast
Prep the patient
Get a history from the patient
Aftercare instructions
and clean up of supplies

15. GU studies GI tract studies
Carlton – Ch. 40 Fluoroscopic Uses Functional studies – xrays in motion
GI tract studies
Esophagus /OPMS
Upper GI
SMB BE
ERCP
GU studies
- VCU's,
RT 255 The “OGRAMS”
Angiograms
Hysterosalpingograms
Venogram
Myelogram
Sialogram
Tube /Line placement
Fistulograms
ETC ETC
PAIN CLINIC (C-ARM)

16. Radiation Safety and Fluoroscopy
Time
Distance
Shielding
The Patient & Scatter

17. Radiation Protection During Fluoroscopy
The patient
The radiographer and radiologist
Others

18. RADIATION PROTECTION The Patient is the largest scattering object
Lower at a 90 DEGREE ANGLE from the patient + PRIMARY BEAM
AT 1 METER DISTANCE -
1/1000 OF INTENSITY PRIMARY XRAY or 0.1%

19. Room design Remember to move the overhead tube out of the way!

20. Protective Barriers
Primary barrier – protection from Primary radiation (for the patient& technologist )
The II is a 2.0 mm pb eq barrier
Secondary barrier - protection from Secondary radiation (from the patient)
- Protection for the technologists, etc

21. Iso Exposure Curves Where is it SAFE??
Behind the lead shield and behind the Radiologist!
Behind the lead shield and behind the Radiologist!

22. Minimum source-to-skin distance
Patient entrance skin exposure (ESE) is higher when the fluoroscopic x-ray tube is too close to the tabletop.
Minimum source-to-skin distance
12” for mobile equipment
15” for stationary systems
Audible alarm at 5 mins.
Same rules for collimation

23. KEEP I.I. CLOSE TO PATIENT
PATIENT EXPOSURE
KEEP I.I. CLOSE TO PATIENT
REDUCE DISTANCE OF IMAGE INTESIFIER
INCREASE DISTANCE FROM THE TUBE
Patient entrance skin exposure (ESE) is ALSO higher when the IMAGE INTENSIFIER is too FAR to from the patient.

24. Over vs Under the table fluoro tubes & Scatter

25. Under table tube vs Over table tube (remote units) Digital & Conventional Fluoro

26. Fluoroscopic X-Ray Tubes
mA range: 0.5 – 5.0 mA
KVP: 70 – 110
depending on exam and contrast used
15” minimum SOD in fixed fluoroscopic equipment
Foot switch (dead man)

27. IsoExposure Curves Where is it SAFE??
VCUG

29. Fluoroscopic Positioning Previewing
Radiographers are trained in positioning
Unnecessary radiation exposure to patient is unethical
Fluoroscopic equipment should not be used to preview patient’s position

30. Principles of Personnel Exposure Reduction
Time
Distance
Shielding
Protective barriers
Protective devices

31. Important to keep the curtain in place

32. Protection of Radiographer and Radiologist
Lead apron
0.25 mm Pb/eq
Highest energy scatter
Same level as radiographer /radiologist’s gonads (135o under table)
OR for eyes (over table 45o) see diagrams
90o angle to the incident beam (lowest)
(without shield – still high
see isoexposure curves)

33. Protection of Radiographer and Radiologist
Used when it is not possible to remain behind a barrier
Lead aprons
Lead gloves
Lead glasses
Thyroid shields
0.25 –1.0 mm lead eq
Protection of Radiographer and Radiologist
Single step away from the table
decreases exposure exponentially (inverse sq law)
Bucky slot cover
Lead rubber drape
Radiologist as shielding

34. Shielding TECHNOLOGIST .25 MM LEAD APRON THYROID SHEILD PATIENT –
WHEN NOT IN AREA OF INTEREST
REMEMBER WHERE THE SOURCE OF
THE XRAY BEAM IS
COMING FROM!
.5MM FOR GONADS
What is the pb eq?
Can this be used for gonads?

35. WHATS WRONG?

37. Tabletop exposure rate Maximum 10 R/min Typically 1 – 3 R/min
Patient Protection
Tabletop exposure rate
Maximum 10 R/min
Typically 1 – 3 R/min
Typical exposure rates
Cinefluorography
7.2 R/min
Cassettes
30 mR/exposure
105 mm film
10 mR/exposure

38. ALARA: As Low As Reasonably Achievable
Radiologic personnel are responsible for minimizing radiation exposure to patients
Achieved through thoughtful approach and application of radiation protection practices
Procedure dose to patient

39. Protection of Others
Radiographer’s responsibility to inform others in the room to wear lead apron
Do not initiate fluoroscopy until all persons have complied

40. Protection of Personnel during FLUOROSCOPY
Radiologic personnel should not hold patients for exposures
Student SHALL not hold patient during radiation exposure
Family or friend better choice
Immobilization devices best choice

41. Bucky Slot Cover

42. TABLE MOVEMENT

43. Always make sure the foot
Board is correctly in place
BEFORE standing a pt on the table
Check weight limit for table

44. BASIC PROCEDURES
For FLUOROSCOPY
Note – do not allow pt to place Cup on the II - Table will move from vertical to horizontal!

45. Depending on the study – the patient may begin in the upright position
The Radiologist may then place the patient and table recumbant to finish the fluoro study
Depending on the study – the patient may begin in the upright position
The Radiologist may then place the patient and table recumbant to finish the fluoro study

46. OVERHEADS taken after DR leaves room
Depending on the study – the patient may begin in the upright position
The Radiologist may then place the patient and table recumbant to finish the fluoro study
OVERHEADS taken after DR leaves room

47. “OVERHEADS” AFTER FLUOROSCOPY IS COMPLETE LARGER FORMAT IMAGE 14X17
DIGITAL 14X14 MAX

51. Enteroclysis procedure (SMB)

52. Single contrast Double Contrast

54. PROCEDURE???

55. Problem ? Pathology? DO NOT give Barium to this Patient……. Why Not?
Will cover with contrast media lecture