1 fluoroscopy intro to equipment rt 244 fall 2008-10 week 1 wed- continued ref: fluoroscopy –...
TRANSCRIPT
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1
Fluoroscopy Intro to EQUIPMENT
RT 244
FALL 2008-10
Week 1
Wed- CONTINUED
Ref: Fluoroscopy – Bushong’s Ch. 24
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2
Basic Componets of “old” Fluoroscopy “Imaging Chain”
Fluoro TUBE
Primary
Radiation PATIENT
EXIT Radiation
Image Intensifier
ABC Image Recording Devices
Fiber Optics OR
105 Photospot
CINE
Cas
sett
e
VIDICON
Camera Tube
CONTROL
UNITTV
LENS
SPLIT
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Conventional I I system
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IMAGE INTENSIFIER
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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
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Anode and Output Screen
Anode Positively charged 25 kVp Hole in center allows electrons to pass through to
output screen OUTPUT SCREEN
Usually 1 inch in diameter Zinc cadnium sulfide coating Changes electrons back to LIGHT
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Image IntensifierPROPERTIES
Image Quality
Contrast
Resolution
Distortion
Quantum mottle
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Contrast
Controlled by amplitude of video signal Affected by:
Scattered ionizing radiation Penumbral light scatter
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Veiling glare Scatter in the form of
x-rays, light & electrons can
reduce contrast of an image
intensifier tube.
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10
Resolution
Video viewing Limited by 525 line raster pattern of monitor
Newer digital monitors 1024 - better resolution
MORE ON THIS LATER IN THE LECTURE
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Image distortion
PINCUSHION EFFECT
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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
Vignetting
FALL-OFF OF BRIGHTNESS AT PERIPHERY (EDGES) OF THE IMAGE
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VIGNETTING…….
Darkness on edges (falloff of brightness)
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Size Distortion
Affected by same parameters as static radiography Primarily OID Can be combated by bringing image intensifier as
close to patient as possible
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ABC
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16 Basic Componets of “old”
Fluoroscopy “Imaging Chain”Fluoro TUBE
Primary
Radiation PATIENT
EXIT Radiation
Image Intensifier
ABC Image Recording Devices
Fiber Optics OR
105 Photospot
CINE
Cas
sett
e
VIDICON
Camera Tube
CONTROL
UNITTV
LENS
SPLIT
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Brightness Control
Automatic brightness stabilization Automatic adjustments made to exposure factors
by equipment Automatic gain control
Amplifies video signal rather than adjusting exposure factors
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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 - IMAGE LAG
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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
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20 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)
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21
Quantum Mottle
Blotchy, grainy appearance Caused by too little exposure Most commonly remedied by increasing Ma Controlled by the ABC Affected by too little technique size of patient distance of II to patient size of collimation
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22 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
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23 KEEP I.I. CLOSE TO PATIENT
reduces beam on time
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25
Units of measurement
INPUT PHOSPHOR – IS MEASURED IN _________________________________
OUTPUT PHOSPHOR IS MEASURED IN ______________________________
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Units of measurement
INPUT PHOSPHOR – IS MEASURED IN
Milliroentgens mR
OUTPUT PHOSPHOR IS MEASURED IN
CANDELAS (LIGHT)
VIEWBOXES ARE MEASURED IN: lamberts (light)
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Fluoroscopic Imaging
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Coupling I.I. to TV Monitor
2 Methods: Fiber optics directly to T.V. camera. Lens system which utilizes auxiliary imaging
devices.
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Directly to T.V.
Only cassettes can be used.
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31
Beam splitting mirror
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32 Basic Componets of “old”
Fluoroscopy “Imaging Chain”Fluoro TUBE
Primary
Radiation PATIENT
EXIT Radiation
Image Intensifier
ABC Image Recording Devices
Fiber Optics OR
105 Photospot
CINE
Cas
sett
e
VIDICON
Camera Tube
CONTROL
UNITTV
LENS
SPLIT
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34
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 to other RECORDING DEVICES
and transmit 10% onto the television camera*. *TV MONITOR is the weakest link (low resolution)
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35 Viewing Fluoroscopic Images
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37
Lenses / Mirrors
Used to direct image to recording devices Several mirrors in a series and angled - the
last mirror is outside the II for the operator to view
Image decreases as it is projected from 1 mirror to the next
Only 1 person can view image
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RECORDING THE IMAGE
STATIC IMAGES
DYNAMIC IMAGES
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39 Basic Componets of “old”
Fluoroscopy “Imaging Chain”Fluoro TUBE
Primary
Radiation PATIENT
EXIT Radiation
Image Intensifier
ABC Image Recording Devices
Fiber Optics OR
105 Photospot
CINE
Cas
sett
e
VIDICON
Camera Tube
CONTROL
UNITTV
LENS
SPLIT
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40 Recording the Fluoroscopic
Image
STATIC IMAGES Cassettes 105 mm chip film = 12 frames per second
Digital fluoroscopy DYNAMIC VIEWING: Cine film Videotape
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41 Recording Fluoroscopic
Images
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42
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 or uses /105 PHOTOSPOT / VIDEO/ CINE
NEWEST = USES DIGITAL !!!!!!!!! (but the tests* still have all of it!)
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43 Basic Componets of “old”
Fluoroscopy “Imaging Chain”Fluoro TUBE
Primary
Radiation PATIENT
EXIT Radiation
Image Intensifier
ABC Image Recording Devices
Fiber Optics
105 Photospot
CINE
Cas
sett
e
VIDICON
Camera Tube
CONTROL
UNITTV
LENS
SPLIT
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44
Fluoroscopy mA
Low, continuous exposures .05 – 5 ma (usually ave 1 – 2 ma)
Radiographic Exposure for cassette spot filmsmA increased to 100 – 200
mA
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45
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
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46
Cassettes
Standard size - 9” x 9” (old) NOW CAN TAKE UP TO 14X14 Stored in lead-lined compartment until ready
for exposure When exposure is made, mA is raised to
radiographic level Multiple image formats
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49
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 1Cassette loaded spot film increases patient dose
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51 Basic Componets of “old”
Fluoroscopy “Imaging Chain”Fluoro TUBE
Primary
Radiation PATIENT
EXIT Radiation
Image Intensifier
ABC Image Recording Devices
Fiber Optics OR
105 Photospot
CINE
Cas
sett
e
VIDICON
Camera Tube
CONTROL
UNITTV
LENS
SPLIT
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52
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53 70 & 105 PHOTOSPOT
(CAMERA)
Photo spot camera will take the image right off the output phosphor
This requires less patient dose 70 & 105 mm roll film
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54 CASSETTE SPOT FILMING
vs 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
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56 CASSETTE SPOT FILMING
vs 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
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57 Recording the Fluoroscopic
Image
Dynamic systems Cine film systems Videotape recording Static spot filming systems
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58 TV camera and video signal
& Recording the image
The output phosphor of the image intensifier is optically coupled to a television camera system.
Beam splitter – is a partially reflective mirror. A pair of lenses focuses the output image onto the
input surface of the television camera. 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 105 mm PHOTOSPOT camera or cine camera.
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59
VIDICONVIDICON
FILMFILM PMPM REFERENCEREFERENCEkVkV
CONTROLLERCONTROLLER
X Ray TUBEX Ray TUBE kVkV
GENERAL SCHEME OF FLUOROSCOPYGENERAL SCHEME OF FLUOROSCOPY
CINE - USED FOR CARDIAC CATH
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60
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
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61
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 ↓)
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62 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”
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63
More on Cine
Synchronization Framing frequency F-number of the optical system Framing and patient dose
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64
Synchronization
Camera shutters and x-ray pulsed fluoro happen at the same time
Only exposes pt when shutter is open to record image
Patient radiation dose ↑ as #/f/sec ↑
(filming a TV show – pattern seen)
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65
F-number of the optical system
Speed of any given camera system The amount of light made available to the
lens
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66 Framing and patient dose
syll = 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
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67 OVERFRAMING vs Exact
Framing
Also related to Radiation Safety………………
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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
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69
More on Safety later….
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70 RECORDING DEVICES
RESOLUTION 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
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71
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72
Line pair gauges
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73Line pair gauges
GOOD RESOLUTION POOR RESOLUTION
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74
Video disc
This technique is referred to as electronic radiography.
Fluoroscopic radiation continues only long enough to build up a useful image on the display monitor.
The image is stored as a single television frame on the video disc recorder.
There is about a 95% reduction in patient dose.
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75
Video tape
Utilizes VHS or high-resolution tapes. Patient’s exposure to radiation is not
increased. Used for barium swallows.
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76
Image Quality - Review
Terms that are necessary to know: Vignetting is the loss of brightness at the
periphery of the II due to the concave surface Pincushion effect is the drop off at the edges of
the II due to the curved surface Quantum mottle is the grainy appearance on the
image due to statistical fluctuations The center of the II will always have the best
resolution. Lag is the blurry image from moving the II too
fast
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77
OVERFRAMING vs Exact Framing
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78
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 - vidiconInside 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
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79
VIDEO/CAMERA TUBE
PLUMICON, VIDICON, ORTHOCON VIDICON MOST COMMOM ORTHOCON – VERY $$$$ PLUMICON – BETTER RESOLUTION TRANSFERS IMAGE FROM OUTPUT
PHOSPHOR TO TV MONITOR CONNECTED BY FIBER OPTICS
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80
VIDEO/CAMERA TUBE
PLUMICON, VIDICON, ORTHOCON, CCD’s TRANSFERS IMAGE FROM OUTPUT PHOSPHOR
TO TV MONITOR CONNECTED BY FIBER OPTICS or Optical Lens
VIDICON- MOST COMMOM PLUMICON – BETTER RESOLUTION CCD – Charged Coupling Devices ORTHOCON – VERY $$$$
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81
VIDEO/CAMERA TUBE VIDICON MOST COMMOM
– good resolution with moderate lag – ok for organs Uses ANTIMONY TRISULFATE
PLUMICON (a modification of Vidicon) – BETTER RESOLUTION / (↓ dose) Better for moving part like the heart –faster response time High performance, lag may improve, but ↑quantum mottle Uses LEAD OZIDE
ORTHOCON – VERY $$$$ - Larger (Not used)BEST RESOLUTION WITH NO LAG Functions as both II and pick up tube
CCD – smaller & longer life, very little image lag
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82
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
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83
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.
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84 Vidicon (tube) TV Camera
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85
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86
camera tube have a diameter of approximately
1 inch and a length of 6 inches.
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87
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88
Parts of the camera tube
Glass envelope Electron gun (Cathode) Control grid Electrostatic grids Target
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89
Camera Tube steps
Light is received by the camera tube. The light from the II is received at the face plate of
the target assembly. Electrons are formed into an electron beam (by the
control grid) at the electron gun. Electrons are burned off by thermionic emission
then focused and accelerated to the target. (made of antimony trisulfide)
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90
Target of the Camera Tube
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91
The electrons scan the signal plate similar to reading a page.
Starting in the upper left across to the right, then back to the left to right.
This is called an active trace. The movement of the electron beam
produces a RASTER pattern. The same pattern occurs in the TV
monitor.
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92
The signal plate sends the electrical video signal to the control unit which amplifies the signal and synchronizes the pulses between the camera tube and the TV monitor.
This synchronization
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93 Vidicon Target Assembly
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94
Viewing Systems
Video camera charge-coupled device (CCD) Video monitor Digital
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95
Video Viewing System
Closed circuit television Video camera coupled to output screen and
monitor Video cameras
Vidicon or Plumbicon tube CCD
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96Synchronization (Sync Signals)
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97
TV camera and video signal (V)
On most fluoroscopy units, the resolution of the system is governed by the number of lines of the television system.
Thus, it is possible to improve the high contrast resolution by increasing the number of television lines.
Some systems have 1,000 lines and prototype systems with 2,000 lines are being developed.
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98 TV Monitor
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99
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.
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100
TV Monitor
The TV monitor contains the picture tube called cathode ray tube (CRT).
It works like the camera tube. With an electron gun and control grids the
electron beam is fired toward the anode. The TV screen contains small fluorescent
crystals
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101
Video Field Interlacing
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102 Different types of scanning
INTERLACED SCANNING
PROGRESSIVESCANNING
12 2
14
4 16
18 6
1
820
13
15
17
10
11
3
21
19
5
7
9
35
1816141210 8 6 4 2
79
11131517
1
625 lines in 40 msi.e. : 25 frames/s
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103
Line pair gaugesGOOD RESOLUTION POOR RESOLUTION
6 LP/MM AT SPOT CASSETTE 2 LP/MM AT TV
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104
Two fields = a frame (525 lines) It take 1/30 of a second. To prevent flicker, two fields are interlaced
to form on television frame. There are 60 fields and 30 frames per
second. The eye cannot detect flickering above 20
frames/sec.
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105
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106
RASTER Pattern
The electron beam moves in the same raster pattern as in the camera tube.
The signal consists of many individual pulses corresponding to the individual location on the camera tube target.
The varying voltage pulses are later reassembled into a visible in by the TV monitor.
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107
TV RESOLUTION-Vertical
Conventional TV: 525 TV lines to represent entire image. Example: 9” intensifier (9” FOV)
1) 9” = 229 mm
2) 525 TV lines/229 mm = 2.3 lines/mm
3) Need 2 TV lines per test pattern line-pair
4) (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
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108
Kell Factor
The ability to resolve objects spaced apart in a vertical direction.
More dots = more scan lines = more/better resolution
Kell factor for 525 line system is 0.7
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109
KELL FACTOR
VERTICAL RESOLUTIONABILITY 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
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110
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)
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111 Bandpass/Horizantal
Resolution
Horizontal resolution is determined by the bandpass.
Bandpass is expressed in frequency (Hz) and describes the number of times per second the electron beam can be modulated.
The higher the bandpass, the better the resolution
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112
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
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113
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114
Final Image
The result of hundreds of thousands of tiny dots of varying degrees of brightness.
These dots are arranged in a specific patterns along horizontal scan lines.
Usually 525 scan lines. The electron gun within the picture tube scans from
top to bottom in 1/60 of a second, (262 1/2 lines) called a field.
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115
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116
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117 TABLE MOVEMENT
horizonatal to upright ~ 30 sec
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118
End of Week 1 Day 2
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119
Digital Fluoro
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120
DIGITAL FLUORO
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121
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122
DIGITAL Fluoro System
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123
ADC –
ANALOG TO DIGITAL CONVERTER
TAKE THE ANALOG ELECTRIC SIGNAL CHANGES IT TO A DIGITAL SIGNAL
TO MONITOR – BETTER RESOLUTION WITH DIGITAL
UNITS
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124
Digital Fluoroscopy
Use CCD to generate electronic signal Signal is sent to ADC Allows for post processing and electronic
storage and distribution
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125
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
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126
CCD’s
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127 Modern Digital Fluoro System
under table tubes
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128
Remote – over the table tube
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129
Remote – over the table tube
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130
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
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131 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
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132
CsI phosphor light detected by the AMA of silicon photodiodes
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133
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134
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135
Digital Uses Progressive Scan
1024 x 1024 Higher spatial resolution As compared to 525
8 images/sec (compared to 30 in 525 system)
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136
DSA & POSTPROCESSING
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137
DSA
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138
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139
Mobile C-arm Fluoroscopy
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140
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141 Fluoro & Rad
Protection INTRO RHB
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142
Regulatory Requirements
1. Regarding the operation of fluoroscopy units
2. Regarding personnel protection
3. Regarding patient protection
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143 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
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144
Patient Protection
Tabletop exposure rate Maximum 10 R/min Typically 1 – 3 R/min
Some books ave is 4 R/min **
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145
Patient Protection
Minimum source-to-skin distance 12” for mobile equipment 15” for stationary systems
Audible alarm at 5 mins. Same rules for collimation
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146
Patient Protection
Typical exposure rates Cinefluorography
7.2 R/min Cassettes
30 mR/exposure 105 mm film
10 mR/exposure
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147
Protection of Radiographer and Radiologist
Single step away from the table decreases exposure exponentially
Bucky slot cover Lead rubber drape Radiologist as shielding
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148
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
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149
PUBLIC EXPOSURE
10 % OF OCCUPATIONAL NON MEDICAL EXPOSURE.5 RAD OR 500 MRADUNDER AGE 18 AND STUDENT.1 rem 1 mSv
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150
COLLIMATION
The PATIENT’S SKIN SURFACE SHOULD NOT BE CLOSER THAN
___________ CM BELOW THE COLLIMATOR?
____________ INCHES?
15 cm / 6.5 inches
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151
Protection
Lots to remember in the summer, for right now:1. Tube in never closer to the patient than 15” in
stationary tubes and 12” with a C arm2. As II moves away from the patient the tube is being
brought closer3. Bucky tray is connected to a lead shield called the
Bucky slot cover. It must be 0.25 mm Pb4. There should be a protective apron of at least 0.25
mm Pb that hangs down from the II5. Every machine is required to have an audible timer
that signals 5 minutes of fluoroscopy time6. Exposure switch must be a “dead man” type
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152
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
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153
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
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154
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
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155
Patient Protection
1. A 2 minute UGI results in an exposure of approximately 5 R!!
2. After 5 minutes of fluoro time the exposure is 10-30 R
3. Use of pulsed fluoro is best (means no matter how long you are on pedal there is only a short burst of radiation)
4. ESE must not be more than 5 rads/min
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156
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
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157
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158
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
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159
SSD – TUBE TO SKIN DISTANCE
FIXED UNITS18” PREFERRED15 “ MINIMUM
MOBILE UNITS ( C-ARMS)12’ MINIMUM
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160
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
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161
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162
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
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163
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 % ♂
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164
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165
KEEP I.I. CLOSE TO PATIENT
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166 Over vs under the table
fluoro tubes
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167 Framing and patient dose
syll = 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
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168
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
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169
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
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170
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
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171
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%
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172
BUCKY SLOT COVER.25 MM LEAD
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173
Bucky Slot Cover
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174
ISOEXPOSURE CURVES
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175
PERSONNEL PROTECTION SCATTER FROM THE PATIENT TABLE TOP, COLLIMATOR, TUBE
HOUSING, BUCKY
STRAY RADIATION – LEAKAGE OR SCATTER RADIATION
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176
TOWER CURTAIN
.25 MM LEAD EQ
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177
Lead curtain & dose reduction
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178
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.
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179
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180
PERSONNEL PROTECTION
STANDING BEHIND A PROTECTIVE PRIMARY (1/16TH pb) BARRIER:
PRIMARY RADIATION EXPOSURE – 99.87% REDUCED
PORTABLE BARRIER = 99 % REDUCTION
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181
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)
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182 PERSONNEL PROTECTION
MONITORING
FILM BADGE TLD POSL
POCKET DOSIMETER
RING BADGE
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183 PERSONNEL PROTECTION
MONITORING
DOSE LIMITS WHOLE BODY EYES EXTREMITIES (BELOW ELBOW/KNEES)
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184
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185
Report at least every quarterPreserved for a minimum of 3 years
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186
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
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187
LICENSE RENEWAL
WITHIN 30 DAYS OF EXPRIATION NOTIFICATION OF CHANGE OF ADDRESS
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188
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 –
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189 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
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190
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
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191
RHB “RULES” RHB RP PG62
ALL XRAYS MUST BE ORDERED BY A PHYSICIAN
VERBAL OR WRITTEN PRESCRIPTION
See Section C – “Technologist Restrictions”
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192
DOSE
CINE - 2mR per frame (60f/sec) 400 mr per “look”
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193 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
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194
FLUOROSCOPYEnd of wk 1RT 244 2008