Fluoroscopy Review

1. Fluoroscopy Review RT 255

2. Basic �Imaging Chain�

3. Conventional I I system

4. Basic Componets of �old� Fluoroscopy �Imaging Chain�

5. Basic Componets of �NEW DIGITAL� Fluoro�Imaging Chain�

6. DIGITAL FLUORO SYSTEM

7. Conventional Fluoroscopic Unit Conventional fluoroscopy User viewed faint image on screen User in direct path of beam Very high dose to user and patient Excellent resolution No longer used

8. Conventional Fluoroscopy

9. Conventional Fluoroscopy

10. Light Levels and Fluoroscopy

11. Image Intensified Fluoroscopy Electronic conversion of screen image to light image that can be viewed on a monitor ? resolution ? dose

12. The image intensifier (I.I.)

13. Modern fluoroscopic system components

14. Modern Fluoroscopic Unit

15. Image intensifier systems

16. Image Intensifier VACUUM TUBE ENCASED IN A LEAD HOUSING = 2MM PB (PRIMARY BARRIER)

17. Cesium Iodide (CsI) Phosphoron Input Phosphor CsI crystals grown linear and packed closely together The column shaped �pipes� helps to direct the Light with less blurring Converts x-ray photons to visible light

18. Veiling glare ��Scatter in the form of x-rays, light & electrons can reduce contrast of an image intensifier tube.

19. Functioning of Image Intensifier

20. IMAGE INTENSIFIER INPUT PHOSPHOR � CESIUM IODIDE PHOTOCATHODE (LIGHT TO E�S) ELECTOSTATIC LENSES � FOCUSES AND ACCELERATES THE E INTENSIFIES LIGHT = BRIGHTNESS GAIN (BG) BG = MG X FG

21. II Image Intensifier The input phosphor converts x-ray to light* Light from the input phosphor is sent to the photocathode made of cesium and antimony compounds* Photocathode turns light into electrons (called photoemission)* Now we have electrons that need to get to the anode

22. Image Intensifier Tube Vacuum diode tube 1. Input phosphor (CsI) X-rays ? light 2. Photocathode Photoemission Light ? electron beam 3. Electrostatic lenses Maintain & minify e- 4. Anode Attracts e- in beam 5. Output phosphor (ZnS-CdS) e- ? light

23. Multi-field II Units II that allows selection of input phosphor size 2 or 3 size selections 25/17 25/17/12 or 23/15/10 Smaller input magnifies output by moving focal point away from output Requires more x-rays to maintain brightness

24. IMAGE INTENSIFIER CESIUM IODIDE � Input Phosphor ZINC CADMIUM SULFIDE � Output phosphor ELECTRON FOCUSING LENS + CURRENT ATTRACTS e TO ANODE 25 � 35 KVP POTIENTIAL ACROSS TUBE Output phosphor contains a thin al plate to prevent light returning to the photocathode

25. The anode of the II The anode is about 20� away from these electrons so what will help move the E�s? Electrostatic lenses have a negative charge to repel the negative electrons and push them to the anode and focus them to a narrow beam* Anode has a hole in the middle of it allowing electrons to pass through and hit the output phosphor made of zinc cadmium sulfide* The electrons are carrying the latent image and when they hit the output phosphor they are turned into light again

27. Image intensifier component Input screen: conversion of incident X Rays into light photons (CsI) 1 X Ray photon creates ? 3,000 light photons Photocathode: conversion of light photons into electrons only 10 to 20% of light photons are converted into photoelectrons Electrodes : focalization of electrons onto the output screen electrodes provide the electronic magnification Output screen: conversion of accelerated electrons into light photons

28. Intensifier Brightness Gain (BG) BG = Minification Gain x Flux Gain Minification gain (MG): The ratio of the squares of the input and output phosphor diameters. This corresponds to �concentrating� the light into a smaller area, thus increasing brightness MG = (Input Diameter )2 (Output Diameter)2

29. Minification Electrons had to be focused down to fit through the hole at the anode Input phosphor is much bigger than the anode opening Input phosphors are 10-35 cm in diameter* (6, 9 , 12 inches) Output phosphors are 2.5 to 5 cm (1 in) in diameter* Most fluoro tubes have the ability to operate in 2 sizes (just like small and large focal spot sizes) Bi focus - M=Newer units - tri focus

30. Intensifier Flux Gain

31. 1000 light photons at the photocathode from 1 x-ray photon photocathode decreased the # of �s so that they could fit through the anode Output phosphor = 3000 light photons (3 X more than at the input phosphor!) This increase is called the flux gain

32. Flux gain The ratio of the number of light photons striking the output screen to the ratio of the number of x-ray photons striking the input screen is called fluxgain

33. Brightness gain The II makes the image brighter because it minified it and more light photons. Multiply the flux gain times the minification gain.

34. BRIGHTNESS CONTROL ABC ABS AEC ADC MAINTAINS THE BRIGHTNESS OF THE IMAGE � BY AUTOMATICALLY ADJUSTING THE EXPSOURE FACTORS (KVP &/OR MAS) FOR THICKER PARTS SLOW RESPONSE TIME - IIMAGE LAG

35. BG = MG X FG FLUX GAIN � increase of light brightness due to the conversion efficiency of the output screen 1 electron = 50 light photons is 50 FG Can decrease as II ages Output phosphor almost always 1 inch Zinc cadnium phosphot Flux gain is almost always 50

36. BG = MG X FG Brightness gain BG = MINIFICATION GAIN X FLUX GAIN (old Patterson B-2 fluoro �obsolete) Brightness gain is a measure of the conversion factor that is the ratio of the intensity of the output phosphor to the input phosphor conversion factor = intensity of OP � mR/sec

37. Image Intensifier Terms Flux Gain (usually stated rather than calculated)

38. Intensifier Performance Conversion factor is the ratio of output phosphor image luminance (candelas/m2) to x-ray exposure rate entering the image intensifier (mR/second). Very difficult to measure: no access to output phosphor No absolute performance criteria

39. Intensifier Brightness Gain Flux Gain (FG): Produced by accelerating the photoelectrons across a high voltage (>20 keV), thus allowing each electron to produce many more light photons in the output phosphor than was required to eject them from the photcathode. Summary: Combining minification and flux gains:

40. Intensifier Brightness Gain Example: Input Phosphor Diameter = 9� Output Phosphor Diameter = 1� Flux Gain = 75 (usually 50) BG = FG x MG = 75 x (9/1)2 = 6075 Typical values: a few thousand to >10,000 for modern image intensifiers

41. Fluoroscopic Noise (Quantum Mottle) Fluoroscopic image noise can only be reduced by using more x-ray photons to produce image. Accomplished in 3 ways: Increase radiation dose (bad for patient dose) Frame-averaging: creates image using a longer effective time Can cause image lag (but modern methods good) Improve Absorption Efficiency of the input phosphor

42. Intensifier Format and Modes

44. Units of measurement INPUT PHOSPHOR � IS MEASURED IN _________________________________ OUTPUT PHOSPHOR IS MEASURED IN ______________________________

45. Units of measurement INPUT PHOSPHOR � IS MEASURED IN Milliroentgens mR OUTPUT PHOSPHOR IS MEASURED IN CANDELAS (LIGHT) VIEWBOXES ARE MEASURED IN: lamberts (light)

46. MAG MODE VS PT DOSE MAG USED TO ENLARGE SMALL STRUCTURE OR TO PENETRATE THROUGH LARGER PARTS PATIENT DOSE IS INCREASED IN THE MAG MODE � DEPENDANT ON SIZE OF INPUT PHOSPHOR

47. MAG MODE FORMULA IP OLD SIZE IP NEW SIZE = %mag

48. PT dose in MAG MODE IP OLD SIZE 2 IP NEW SIZE 2 = ? pt dose

49. Minification gain - again BG = MINIFICATION GAIN X FLUX GAIN MINIFICATION GAIN � same # e at input condensed to output phosphor � ratio of surface area on input screen over surface area of output screen IP SIZE 2 OP SIZE 2

50. ABC Automatic brightness control allows Radiologist to select brightness level on screen by ? kVp or ? mAs Automatic dose control Located just beyond the Output Phosphor Will adjust according to pt thickness

51. Brightness Control Automatic brightness stabilization Automatic adjustments made to exposure factors by equipment Automatic gain control Amplifies video signal rather than adjusting exposure factors

52. Automatic Brightness Control Monitoring Image Brightness Photocell viewing (portion of) output phosphor TV signal (voltage proportional to brightness) Brightness Control: Generator feedback loop kVp variable mA variable/kV override kV+mA variable Pulse width variable (cine and pulsed fluoro) less dose with pulsed vs continous fluoro

53. Fluoroscopic Dose Rates

54. Intensifier Format and Mag Modes

55. Image Quality Contrast Resolution Distortion Quantum mottle

56. Contrast Controlled by amplitude of video signal Affected by: Scattered ionizing radiation Penumbral light scatter

57. Resolution Video viewing Limited by 525 line raster pattern of monitor Newer digital monitors 1024 - better resolution

58. Size Distortion Affected by same parameters as static radiography Primarily OID Can be combated by bringing image intensifier as close to patient as possible

59. Shape Distortion Geometric problems in shape of input screen Concave shape helps reduce shape distortion, but does not remove it all Vignetting or pin cushion effect

60. Image distortion

61. Quantum Mottle Blotchy, grainy appearance Caused by too little exposure Most commonly remedied by increasing mA

62. Beam splitting mirror Often a beam splitting mirror is interposed between the two lenses. The purpose of this mirror is to reflect part of the light produced by the image intensifier onto a 100 mm camera or cine camera. Typically, the mirror will reflect 90% of the incident light and transmit 10% onto the television camera.

63. Viewing Fluoroscopic Images

64. Recording the Fluoroscopic Image STATIC IMAGES Cassettes 105 mm chip film = 12 frames per second Digital fluoroscopy DYNAMIC VIEWING: Cine film Videotape

65. TV camera connections several ways to connect the TV camera to the II. fiber optics bundle to allow light off the output phosphor to go to the TV camera � OLD UNITS - only recording device was??? lens coupling device that allows the light from the output phosphor to be split by a mirror so that a portion is sent to the TV camera and a portion is sent to the film camera.

66. IMAGE RECORDING OLD II - ONLY FIBER OPTICS �NO LENS SPLITTER TO OTHER RECORDING DEVICES ONLY RECORED IMAGE ON SPOT CASSETTES (9X9 ONLY) NEWER - TAKES CASSETTES /105 PHOTOSPOT / VIDEO/ CINE

67. Recording the Fluoroscopic Image Dynamic systems Cine film systems Videotape recording Static spot filming systems

68. Image recording Cassette loaded spot film Where is the tube? How should you put the IR into the II slot? You can format the image, 2 on 1, 4 on 1 or 1 on 1 Cassette loaded spot film increases patient dose Photo spot camera will take the image right off the output phosphor This requires less patient dose

69. Cassettes Standard size - 9� x 9� Stored in lead-lined compartment until ready for exposure When exposure is made, mA is raised to radiographic level Multiple image formats

71. RECORDING IMAGES OLD (Smaller) II with fiber optic ONLY RECORDING WAS CASSETTE CASSETTE �SPOT� IMAGES TAKEN DURING FLUORO PROCEDURE VERY OLD 9X9 inch cassettes Later could take up to 14 x 14 inches

72. Cine Film Systems Movie camera intercepts image 16 mm and 35 mm formats Record series of static exposures at high speed 30 � 60 frames per second Offer increased resolution At the cost of increased patient dose

73. Fluoroscopy mA Low, continuous exposures .05 � 5 ma (usually ave 1 � 2 ma) Radiographic Exposure (for cassette spot films) mA increased to 100 � 200 mA

74. CASSETTE SPOT FILMINGvs PHOTOSPOT FILMING First type of recording used 9x9 cassettes then later up to 14x 14 9 on 1, 4 on 1, 2 on 1 Delay while filming (anatomy still moving) Radiographic mA - must boost up to 100 � 200 mA for filming And moving cassettes around inside tower Higher patient dose Replaced by Photospot (f/sec) filming

75. CASSETTE SPOT FILMINGvs PHOTOSPOT FILMING Photospot (f/sec) filming � Set at control panel from 1 f/sec � 12 f/sec Used for rapid sequence: Upper Esophogram Voiding Cystourethrograms (Peds) Lower patient dose

78. RECORDING DEVICESRESOLUTION P 542 (3rd ed) OPTICAL MIRROR � BEST BUT NOT PERMANENT RECORDING MEDIUM SPOT FILM CASSETTES 6LP/MM PHOTO SPOT 105 / 70 CINE 35 MM / 16 MM DIGITAL (?) (VS FILM) VIDEO � VIEWING REALTIME VIDEO TAPE - PLAYBACK

80. Other Recording From II - Light is split by lenses Beam splitter � is a partially reflective mirror. It allows about 80-90% is transmitted to the camera tube Remaining light directed to recording systems: ex: Cine

82. Cinefluorgraphy aka CINE 35 or 16 mm roll film (movie film) 35 mm ? patient dose / 16 mm � higher quality images produced 30 f/sec in US � (60 frames / sec) THIS MODALITY = HIGHEST PATIENT DOSE (10X greater than fluoro) (VS SINGLE EX DOSE IS ?)

83. Cine Cinefluorography is used most often in cardiology and neuroradiology. The procedure uses a movie camera to record the image from the image intensifier. These units cause the greatest patient doses of all diagnostic radiographic procedures, although they provide very high image quality. The high patient dose results from the length of the procedure and relatively high inherent dose rate. For this reason special care must be taken to ensure that patients are exposed at minimum acceptable levels. Patient exposure can be minimized in a number of ways. The most obvious means of limiting exposure is to limit the time the beam is on. CINE - 2mR per frame (60f/sec) 400 mr per �look�

85. Framing frequency Number of frames per second Cine � division of 60 (7.5, 15,30,90,120) Organ if interest determines f/s rate Patient exposu

86. OVERFRAMING vs Exact Framing

87. Monitoring The output phosphor of the II is connected directly to a TV camera tube when the viewing is done through a television monitor. The most commonly used camera tube - vidicon Inside the glass envelope that surrounds the TV camera tube is a cathode, an electron gun, grids and a target. Past the target is a signal plate that sends the signal from the camera tube to the external video device

88. VIDEO/CAMERA TUBE PLUMICON, VIDICON, ORTHOCON VIDICON MOST COMMOM ORTHOCON � VERY $$$$ PLUMICON � BETTER RESOLUTION TRANSFERS IMAGE FROM OUTPUT PHOSPHOR TO TV MONITOR CONNECTED BY FIBER OPTICS

89. Type of TV camera VIDICON TV camera improvement of contrast improvement of signal to noise ratio high image lag PLUMBICON TV camera (suitable for cardiology) lower image lag (follow up of organ motions) higher quantum noise level CCD TV camera (digital fluoroscopy) digital fluoroscopy spot films are limited in resolution, since they depend on the TV camera (no better than about 2 lp/mm) for a 1000 line TV system

90. TV camera and video signal (II) Older fluoroscopy equipment will have a television system using a camera tube. The camera tube has a glass envelope containing a thin conductive layer coated onto the inside surface of the glass envelope. In a PLUMBICON tube, this material is made out of lead oxide, whereas antimony trisulphide is used in a VIDICON tube.

91. Vidicon (tube) TV Camera

93. camera tube have a diameter of approximately 1 inch and a length of 6 inches.

94. Vidicon Target Assembly

95. Viewing Systems Video camera charge-coupled device (CCD) Video monitor Digital

96. Video Viewing System Closed circuit television Video camera coupled to output screen and monitor Video cameras Vidicon or Plumbicon tube CCD

98. Video Field Interlacing

99. TV Monitor

100. TV MONITOR CRT � Cathode Ray Tube Much larger than camera tube � but similar function The electrons are synchronized by the control unit � so they are of the same intensity and location as the electrons generated by the pick up (camera) tube.

101. Different types of scanning

102. Synchronization (Sync Signals)

103. TV RESOLUTION-Vertical Conventional TV: 525 TV lines to represent entire image. Example: 9� intensifier (9� FOV) 9� = 229 mm 525 TV lines/229 mm = 2.3 lines/mm Need 2 TV lines per test pattern line-pair (2.3 lines/mm) /2 lines/line-pair = 1.15 lp/mm Actual resolution less because test pattern bars don�t line up with TV lines. Effective resolution obtained by applying a Kell Factor of 0.7. Example: 1.15 x 0.7 Kell Factor = 0.8 lp/mm

104. KELL FACTOR VERTICAL RESOLUTION ABILITY TO RESOLVE OBJECTS SPACED APART IN A VERTICAL DIRECTION MORE DOTS(GLOBULES) = MORE SCAN LINES = MORE/BETTER RESOLUTION RATIO OF VERTICAL RESOLUITON # OF SCAN LINES KELL FACTOR FOR 525 LINE SYSTEM IS 0.7

105. TV RESOLUTION-Horizontal Along a TV line, resolution is limited by how fast the camera electronic signal and monitor�s electron beam intensity can change from minimum to maximum. This is bandwidth. For similar horiz and vertical resolution, need 525 changes (262 full cycles) per line. Example (at 30 frames/second): 262 cycles/line x 525 lines/frame x 30 frames/second = 4.2 million cycles/second or 4.2 Megahertz (MHz)

106. TV SYSTEMS Images are displayed on the monitor as individual frames � which tricks the eye into thinking the image is in motion (motion integration) 15 f/sec � eye can still see previous image Weakest Link - 2 lp /mm resolution Real Time

108. TABLE MOVEMENThorizonatal to upright ~ 30 sec

109. Digital Fluoro

110. DIGITAL FLUORO

112. DIGITAL Fluoro System

113. ADC � ANALOG TO DIGITAL CONVERTER TAKE THE ANALOG ELECTRIC SIGNAL CHANGES IT TO A DIGITAL SIGNAL TO MONITOR � BETTER RESOLUTION WITH DIGITAL UNITS

114. Digital Fluoroscopy Use CCD to generate electronic signal Signal is sent to ADC Allows for post processing and electronic storage and distribution

115. Video Camera Charged Coupled Devices (CCD) Operate at lower voltages than video tubes More durable than video tubes Semiconducting device Emits electrons in proportion to amount of light striking photoelectric cathode Fast discharge eliminates lag

116. CCD�s

117. Modern Digital Fluoro Systemunder table tubes

118. Remote � over the table tube

120. Newer Digital Fluoroscopy Image intensifier output screen coupled to TFTs TFT photodiodes are connected to each pixel element Resolution limited in favor of radiation exposure concerns

121. Digital � CCD using cesium iodide Exit x-rays interact with CsI scintillation phosphor to produce light The light interact with the a-Si to produce a signal The TFT stores the signal until readout, one pixel at a time

122. CsI phosphor light detected by the AMA of silicon photodiodes

125. Digital Uses Progressive Scan 1024 x 1024 Higher spatial resolution As compared to 525 8 images/sec (compared to 30 in 525 system)

126. DSA & POSTPROCESSING

127. DSA

129. Mobile C-arm Fluoroscopy

131. Fluoro & Rad Protection review RHB

132. Regulatory Requirements 1. Regarding the operation of fluoroscopy units 2. Regarding personnel protection 3. Regarding patient protection shielding for image intensifier cumulative timer dead-man switch shielding for image intensifier cumulative timer dead-man switch

133. 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

134. Patient Protection Tabletop exposure rate Maximum 10 R/min Typically 1 � 3 R/min Some books ave is 4 R/min **

135. Patient Protection Minimum source-to-skin distance 12� for mobile equipment 15� for stationary systems Audible alarm at 5 mins. Same rules for collimation

136. Patient Protection Typical exposure rates Cinefluorography 7.2 R/min Cassettes 30 mR/exposure 105 mm film 10 mR/exposure

137. Protection of Radiographer and Radiologist Single step away from the table decreases exposure exponentially Bucky slot cover Lead rubber drape Radiologist as shielding

138. 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

139. PUBLIC EXPOSURE 10 % OF OCCUPATIONAL NON MEDICAL EXPOSURE .5 RAD OR 500 MRAD UNDER AGE 18 AND STUDENT .1 rem 1 mSv

140. COLLIMATION The PATIENT�S SKIN SURFACE SHOULD NOT BE CLOSER THAN ___________ CM BELOW THE COLLIMATOR? ____________ INCHES?

141. Protection Lots to remember in the summer, for right now: Tube in never closer to the patient than 15� in stationary tubes and 12� with a C arm As II moves away from the patient the tube is being brought closer Bucky tray is connected to a lead shield called the Bucky slot cover. It must be 0.25 mm Pb There should be a protective apron of at least 0.25 mm Pb that hangs down from the II Every machine is required to have an audible timer that signals 5 minutes of fluoroscopy time Exposure switch must be a �dead man� type

142. Regulations about the operation Fluoroscopic tubes operate at currents that range from0.5 to 5 mA with 3 the most common AEC rate controls: equipment built after 1974 with AEC shall not expose in excess of 10 R/min; equipment after 1974 without AEC shall not expose in excess of 5 R/min

143. Other regulations Must have a dead man switch Must have audible 5 min. exposure timer Must have an interlock to prevent exposure without II in place Tube potential must be tested (monitored)weekly Brightness/contrast must be tested annually Beam alignment and resolution must be tested monthly Leakage cannot exceed 100mR/hr/meter

144. Fluoroscopy exposure rate For radiation protection purposes the fluroscopic table top exposure rate must not exceed 10 mR/min. The table top intensity should not exceed 2.2 R/min for each mA of current at 80 kVp

145. Patient Protection A 2 minute UGI results in an exposure of approximately 5 R!! After 5 minutes of fluoro time the exposure is 10-30 R Use of pulsed fluoro is best (means no matter how long you are on pedal there is only a short burst of radiation) ESE must not be more than 5 rads/min

146. Rad Protection Always keep the II as close to the patient as possible to decrease dose Highest patient exposure happens from the photoelectric effect (absorption) Boost control increases tube current and tube potential above normal limits Must have continuous audible warning Must have continuous manual activation

148. ESE FOR FLUORO TLD PLACED AT SKIN ENTRACE POINT 1 � 5 R/MINUTE AVE IS 4 R/MIN INTERGRAL DOSE � 100 ERGS OF TISSUE = 1 RAD EXPOSURE OR 1 GM RAD = 100 ERGS

149. SSD � TUBE TO SKIN DISTANCE FIXED UNITS 18� PREFERRED 15 � MINIMUM MOBILE UNITS ( C-ARMS) 12� MINIMUM

150. PATIENT PROTECTION LIMIT SIZE OF BEAM BEAM ON TIME DISTANCE OF SOURCE TO SKIN PBL FILTRATION (2.5 mm Al eq) @ 70 SHEILDING SCREEN/FILM COMBO

152. GONAD SHIELDING MUST BE . 5 MM OF LEAD MUST BE USED WHEN GONADS WILL LIE WITHING 5 CM OF THE COLLIMATED AREA (RHB) KUB. Lumbar Spine Pelvis male vs female shielding

153. Gonad shielding & dose ? receive 3x more dose than ? for pelvic x-rays 1 mm lead will reduce exposure (primary) by about 50% ? by about 90 � 95 % ?

155. KEEP I.I. CLOSE TO PATIENT

156. Over vs under the table fluoro tubes

157. Framing and patient dosesyll = Pg 31 The use of the available film area to control the image as seen from the output phosphor. Underframing Exact Framing, (58 % lost film surface) Overframing,(part of image is lost) Total overframing

158. EXPOSURE RATES FLUORO MA IS 0.5 MA TO 5 MA PER MIN AVE DOSE IS 4 R / MIN IF MACHINE OUTPUT IS 2 R/MA/MIN = WHAT IS PT DOSE AT 1.5 MA FOR 5 MIN STUDY? 15R

159. EXPOSURE RATES FOR FLUORO CURRENT STANDARD 10 R/MIN (INTENSIFIED UNITS) HLC: BOOST MODE 20 R/MIN OLD (1974) NO ABC NON IMAGE INTES 5 R/MIN

160. DOSE REGULATIONS BEFORE 1974 - AT TABLETOP 5R/MIN (WITHOUT AEC) 5R/MIN (WITHOUT AEC) � BOOST MODE After 1974 with AEC 10 R/MIN 20R/MIN BOOST

161. RADIATION PROTECTIONThe 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%

162. BUCKY SLOT COVER .25 MM LEAD

163. Bucky Slot Cover

164. ISOEXPOSURE CURVES

165. PERSONNEL PROTECTION SCATTER FROM THE PATIENT TABLE TOP, COLLIMATOR, TUBE HOUSING, BUCKY STRAY RADIATION � LEAKAGE OR SCATTER RADIATION

166. TOWER CURTAIN .25 MM LEAD EQ

167. Lead curtain & dose reduction

168. Pulsed Fluoro Some fluoroscopic equipment is designed for pulsed-mode operation. With the pulsed mode, it can be set to produce less than the conventional 25 or 30 images per second. This reduces the exposure rate. Collimation of the X ray beam to the smallest practical size and keeping the distance between the patient and image receptor as short as possible contribute to good exposure management.

170. PERSONNEL PROTECTION STANDING BEHIND A PROTECTIVE PRIMARY (1/16TH pb) BARRIER: PRIMARY RADIATION EXPOSURE � 99.87% REDUCED PORTABLE BARRIER = 99 % REDUCTION

171. PERSONNEL PROTECTION PROTECTIVE APRONS � 0.25 PB = 97% ? TO SCATTER 0.5 PB = 99.9% ? TO SCATTER THYROID SHEILDS (0.25 & 0.5) GLOVES (0.25 & 0.5)

172. PERSONNEL PROTECTIONMONITORING FILM BADGE TLD POSL POCKET DOSIMETER RING BADGE

173. PERSONNEL PROTECTIONMONITORING DOSE LIMITS WHOLE BODY EYES EXTREMITIES (BELOW ELBOW/KNEES)

175. Report at least every quarterPreserved for a minimum of 3 years

176. RHB NOTIFICATION (EXP IN 24 HOURS) (RP Syllabus � pg 68) IMMEDIATE reporting � WITHIN 24 HOURS TOTAL DOSE OF 25 rems Eye dose � 75 rem Extremity � 250 RADS OVEREXPOSURE � received w/in 24 hrs Must be ReportedWITHIN 30 DAYS TOTAL DOSE OF 5 rems Eye dose � 15 rem Extremity - 50 REMS

177. LICENSE RENEWAL WITHIN 30 DAYS OF EXPRIATION NOTIFICATION OF CHANGE OF ADDRESS

178. 100 mRem ( 0.1 rem / (1 msV) @ 30 cm from the source of radiaton RADIAITON AREA � RHB: 5 mRem ( 0.005 rem / (.05 msV) @ 30 cm from the source of radiation PUBLIC 2 mrem per week* (STAT) HIGH RADIAITON AREA �

179. A �controlled area� is defined as one that is occupied by people trained in radiologic safety that is occupied by people who wear radiation monitors whose occupancy factor is 1

180. RHB �RULES� RHB RP PG61 LICENTIATES OF THE HEALING ARTS (MD, DO, DC, DPM) MUST HAVE A RADIOLOGY SUPERVISOR & OPERATORS PERMIT & CERTIFICATE TO OPERATE OR SUPERVISE THE USE OF X-RAYS ON HUMANS SUPEVISORS MUST POST THEIR LICENSES

181. RHB �RULES� RHB RP PG62 ALL XRAYS MUST BE ORDERED BY A PHYSICIAN VERBAL OR WRITTEN PRESCRIPTION See Section C � �Technologist Restrictions�

182. DOSE CINE - 2mR per frame (60f/sec) 400 mr per �look�

183. Declared Pregnant Worker Must declare pregnancy � 2 badges provided 1 worn at collar (Mother�s exposure) 1 worn inside apron at waist level Under 5 rad � negligible risk Risk increases above 15 rad Recommend abortion (spontaneous) 25 rad (�Baby exposure� approx 1/1000 of ESE) www.ntc.gov/NRC/RG/08/08-013.html

184. FLUOROSCOPYREVIEWRT 255