1. Rad Tech 265 More Digital Imaging

2. Digital Fluoroscopy • Radiation dose • Patient dose for DF is significantly less than conventional fluoro • At 7.5 pulses/second DF has a 75% drop in exposure • At 3 pulses/sec a 90% reduction in dose • The lower dose is obviously advantageous for pediatric work.

3. Types of DF • The most common methodology is to add a CCD to the video chain. • A truly digital system can be either indirect or direct. • Pulse progressive fluoroscopy • Uses a high frequency generator with regular mA values

4. Digital Fluoroscopy Room

5. Flat panel vs. Image Intensifier Flat panel II Field coverage / size advantage to flat panel Image distortion advantage to flat panel

6. Flat vs. Fat

7. Direct DF • In direct capture or direct to digital systems, x-ray energy is not converted to light. Instead, it is captured by a thin film transistor matrix of a material such as amorphous selenium that changes it into electronic signals. No intensifying screen is required, and none of the energy is lost through scatter, as happens when x-ray energy is converted to light on its way to display of an image.

8. Indirect DF • The indirect capture systems, including some flat panel displays that can be integrated into analog systems, are similar conceptually to the traditional film-screen technology. In one version, a cesium iodide scintillator captures the x-rays as they exit the patient and converts them to light. This light is turned into electronic signals by a matrix of amorphous silicon sensors. Each sensor corresponds to a single pixel of the image and is connected to a readout line. The signals from each cell in the matrix are read out in sequence row by row to obtain the image. High information transfer rates permit the display of moving images.

9. Indirect v. Direct • Notice, that the comparison of direct v. indirect digital fluoroscopy is the same as direct v. indirect digital radiography. • In the indirect systems, the photons are converted to a light image first before being digitized.

10. Direct v. Indirect

11. Direct v. Indirect Resolution

12. Digital v Conventional Film

13. Digital v. Analog

14. Acquisition steps

15. Image Manipulation with DF • Pan/zoom, background noise reduction, adjustable contrast and brightness, edge enhancement, quantitative analysis of vessel diameter and stenosis severity, subtraction capabilities, roadmapping, and bolus chase are common.

16. Pixels (matrix)

17. Matrix size 32 x 32 128 x 128

18. Matrix size 128 x 128 512 x 512

19. Edge enhancement

20. Bits (gray scale)

21. Bits 4 bits 8 bits

22. Temporal averaging

23. Last image hold (lih)

24. DSA

25. DSA

26. DSA

27. Right Left Shift images to select plane Add to create tomogram Digital Tomosynthesis: reduce structurednoise • 3 cm above detector • 9 views, + to - 30° • 1.4 x dose Tomographic ramp Niklason, L.T. et.al. Radiology 205:399-406