GROUP 4

1. Irfan Nurhady (P1337430117060)

2. Dyah Ayu Dwi W (P1337430117061) KELAS IB
3. Muhamad Fakhrul Rivan (P1337430117062)
4. Galih Tama Ramadhani (P1337430117063)
 Fluoroscopy is a study of moving body structures--
similar to an X-ray "movie." A continuous X-Ray beam is
passed through the body part being examined. The beam is
transmitted to a TV-like monitor so that the body part and
its motion can be seen in detail. Fluoroscopy, as an
imaging tool, enables physicians to look at many body
systems, including the skeletal, digestive, urinary,
respiratory, and reproductive systems.
 Fluoroscopy may be performed to evaluate specific
areas of the body, including the bones, muscles, and joints,
as well as solid organs, such as the heart, lung, or kidneys.
Other related procedures that may be used to diagnose
problems of the bones, muscles, or joints include X-rays,
myelography (myelogram), computed tomography (CT
scan), magnetic resonance imaging (MRI), and
arthrography.
 At the time of fluoroscopy, the primary x-ray beam
penetrates the patient's body to the input screen located in
the Image Intensifier Tube, a vacuum tube comprising a
cathode and an anode. The screen input in the Image
Intensifier is a screen that absorbs x-ray photons and
converts them into visible light beams, which will then be
captured by PMT (Photo Multiplier Tube). PMT consists of
photocatada, focusing electrode, and anode and phosphor
output. The visible light absorbed by the photocathode on
the PMT will be converted to electrons, then by focusing
electrodes the negative electrons from the photocattoes are
focussed and accelerated to the first dinode.
 Then the electrons will hit the first dinoda and in the
collision process will produce other electrons. The
multiplied electrons that emerge from the first dinda will be
accelerated to the second dinode so that it will produce more
electrons, and so on until the last dinoda. After that the
electrons are rapidly accelerated to the anode due to the
potential difference which then the electrons are converted
into electrical signals.
The electrical signal will be forwarded to the amplifier and
then amplified and multiplied. Once these electrical signals
are amplified it will be forwarded to the ADC (Analog to
Digital Converter). In ADC these electrical signals will be
converted into digital data that will be displayed on the tv
monitor in the form of a picture of fluoroscopy results.
The image intensifier is acomplex electronic devic that
receives the remnant X-Ray beam, converts it into light, and
increases the light intesity.
Image Intesifier Tube Components:
1. Glass envelope
2. Input phosphor
3. Photocathode
4. Electrostatic focusing lenses
5. Output phosphor
1. Glass envelope:
Mantains tube vacumm to allow control of e flow, has
no functional part in image formation.
2. Input phosphor :
X-Rays that exit the patient and are incident on the
image intensifier tube are transmitted trough the glass
envelope and interact with the input phosphor, which is
cesium iodide. When X-Rays interacts with the input
phosphor, its energy is converted into a burst of visible
light photons as occur on the intensifying screen. Imput
phosphor materials:
3. Photocathode:
It is bonded directly to the input phosphor with a thin,
transparant, adhesive layer.
The photocathode is athin metal layer, usually composed
of cesium and antimony compounds., that respond to
stimulation by light with the emission of electron. This
process is known as photoemission.
4. Electrostatic focusing lenses
Located along lenghth of the tube, responsible for
focusing the electrons across the tube from input to
output phosphor. Image is reversed from input to output
phosphor. The concave input screen reduces distortion by
keeping the same distance between all points on the
input & output screens.
5. Output phosphor
The output phosphor is usually made up of zinc
cadmium sulfide crystals. Each photoelectron that
arrives at the output phosphor result in approximately
50-70 times.
Image Monitoring
Two methods are used to electronically convert the visible
image on the output phosphor of the image intensifier into
an electronic signal.
1. Thermionic television camera tube
2. The solid state charge-coupled device (CCD)
Camera
• The television camera consist of cylindrical housing,
approximately 15 mm in diameter by 25v cm in length,
that contains the heart of the camera, TV camera tube.
• It also contains electromagnetic coils that are ued to
properly steer the electron beam inside the tube.
• A number of such television camera tubes are available for
television fluorpscopy, but the vidicon and its modified
version, the Plumbicon, are used most often.
• Two methods are commonly used to couple the television
camera tube to the image-intensifier tube.
- fiber optics
-lens system
• The simplest method is to use a bundle of fiber optics
• One advantage of this type of coupling is its compact
assembly, which makes it easy to move the image-
intensifier lower. This coupling is rugged and can
withstand relatively rough handling.
• The principal disavantage is that it cannot accommodate
the additional optics required for devices such as cine or
photospot camera.
Lens Coupling
To accept a cine or photospot camera, lens coupling is
required. This type of coupling result in a much larger
assembly that should be handled with care.
Working
The objective lens accepts light from the output
phosphor and converts it in to a parallel beam. When an
image is recorded on film, this beam is interrupted by a
beam-splitting mirror so that only a portion is transmitted
to the television camera, the remainder is reflected to a
film camera. Such a system allows the fluoroscopist to
view the image while it is being recorded.
• The video signal is amplified and is transmitted by cable
to the television monitor, where it is transformed back into
a visible image.
• What examinations might
include fluoroscopy?
• Exams that might include the use
of fluoroscopy as part of the
procedure include:
• Upper gastroinrestinal
• Small bowel series
• Barium enema
• Enteroclysis
Upper Gastroinrestinal
An upper gastrointestinal series (UGI) is a fluoroscopic
examination of the esophagus, stomach, and duodenum (first
part of the small intestine). The patient drinks a liquid
suspension called Barium Sulfate, which outlines the anatomy of
the esophagus, stomach and duodenum under fluoroscopy.
Usually the patient will drink different types of barium solutions,
effervescent granules, and often a barium tablet. Sometimes
water soluble contrast is used when a leak is suspected.
•
Small Bowel Series
A Small Bowel Series is a diagnostic procedure,
which uses a "contrast agent" called barium sulfate and x-
rays to obtain clear pictures of your small bowel.
Ordinarily, x-rays pass through the soft tissues of the
body, such as those found in your small bowel. However,
barium sulfate coats the walls of your small bowel,
thereby casting shadows that can be recorded in x-ray
film. The exam can detect problems within your small
bowel. A Small Bowel Series procedure helps the
radiologist identify these problems with minimal risk and
discomfort to you.
Barium Enema
A barium enema is a special x-ray of the lower
digestive tract, colon or large intestine. A liquid barium
preparation is given by enema to make the colon and
rectum visible to x-ray. The barium (contrast medium)
makes the area to be examined visible on film. If you are
experiencing pain, have a change in bowel habits; diarrhea
or bleeding your physician may refer you for a barium
enema.
Enteroclysis
• Enteroclysis is an examination of the small bowel. X-rays
are used to take single pictures and a special form of x-ray
called fluoroscopy is also used in this examination. The
radiologist can see internal organs like the bowel in
motion using fluoroscopy.
• A liquid called a contrast agent is put into the small bowel
through a tube passed through your nose and stomach into
the beginning of the small bowel. The contrast agent most
commonly used for this study is called barium. The
radiologist will watch to see how the contrast moves
through the small bowel.
• Schueler BA. The AAPM/RSNA physics tutorial for residents
general overview of fluoroscopic imaging. RadioGraphics, 2000.
20(4):p1115-1126. Available at:
http://pubs.rsna.org/doi/full/10.1148/radiographics.20.4.g00jl301115.
Accessed October 23, 2014.
• Bushberg JT, Seibert JA, Leidholdt EM, Boone JM. The Essential
Physics of Medical Imaging. Philadelphia, PA, Lippincott Williams
& Wilkins; 3rd ed, 2012. Available at:
http://books.google.com/books?id=RKcTgTqeniwC&printsec=frontc
over&dq=The+Essential+Physics+of+Medical+Imaging,+3rd+Editio
n&hl=en&sa=X&ei=L-
tIVLbCIs6zyASEioK4Bw&ved=0CDIQ6AEwAA#v=onepage&q=T
he%20Essential%20Physics%20of%20Medical%20Imaging%2C%2
03rd%20Edition&f=false