X-ray Applications.pptx

10cm
Applications of X-Ray:
Fluoroscopy
Angiography
lithotripsy
2022
Sana’a
Done by:
Abrar Mohammed Aisha Mohammed
Malak Ayman Shaima
Mohammed
Asma Saleh
Under Supervision of:
Dr. Hussam Al-Hitari

10cm
1. Introduction
2. Working Principle
3. Benefits & Risks
4. Main Components
Contents:
2
contents
5. Maintenance and Calibration
6. Common Malfunctions
7. Devices Specifications
8. References

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1. Introduction
Medical imaging has led to improvements in the
diagnosis and treatment of numerous
medical conditions in children and adults.
3
1.Intro.

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There are many types - or modalities
- of medical imaging procedures
which all use radiation including:
4
1.Intro.
• General X-ray
• Computed Tomography
(CT)
• Fluoroscopy
• Mammography
• Dexa Bone Density
• Angiography
• Lithotripsy
• Dental Cone-beam
Computed Tomography.

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Most of these medical imaging provide some
advantages over other techniques which includes:
• Noninvasively
and painlessly
help to diagnose
disease and
monitor therapy.
• Support medical
and surgical
treatment
planning.
• Guide medical
personnel as they
insert catheters,
stents, or other
devices inside the
body, treat tumors, or
remove blood clots or
other blockages.
5
1.Intro.

10cm 6
1.1 Fluoroscopy
1.1 Fluoroscopy:
● 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.

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Fluoroscopy
7
1.1 Fluoroscopy
Fluoroscopy, or real-time projection
X-ray imaging, has been in clinical use
since shortly after Roentgen’s
discovery of X-rays. Early
fluoroscopes consisted simply of an
X-ray source and a fluorescent screen,
between which the patient was
placed.
In modern systems, the fluorescent screen is
coupled to an electronic device that amplifies
and transforms the glowing light into a video
signal suitable for presentation on an electronic
display.

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What are the reasons for a fluoroscopy?
8
1.1 Fluoroscopy
Fluoroscopy is used in many types of examinations and procedures, such as:
• barium X-rays,
• cardiac catheterization,
• intravenous pyelogram,
• hysterosalpingogram,
• lumbar puncture,
• arthrography (visualization of a joint or joints),
• placement of intravenous (IV) catheters (hollow tubes inserted into veins or arteries),
• and biopsies.
Fluoroscopy may be used alone as a diagnostic procedure, or may be used in
conjunction with other diagnostic or therapeutic media or procedures.

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1.2 Angiography:
9
1.2 Angiography
Angiography is a type of X-ray used to
check blood vessels. Blood vessels do
not show clearly on a normal X-ray, so
a special dye needs to be injected into
your blood first. This highlights your
blood vessels, allowing your doctor to
see any problems. The X-ray images
created during angiography are called
angiograms.
Angiography is used to check the health of the
blood vessels and how blood flows through them.

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Why angiography is used?
It can help to diagnose or investigate
several problems affecting blood vessels,
including:
• Atherosclerosis
• Peripheral Arterial Disease
• Brain Aneurysm
• Angina
• Blood Clots or A Pulmonary Embolism
• Blockage in The Blood Supply to
Kidneys
10
1.2 Angiography

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What happens during angiography?
11
1.2 Angiography
• The patient will usually be
awake, but may be given a
medicine called a sedative to
help relax
• The patient lies on an X-ray
table and a small cut (incision)
is made over 1 of his arteries,
usually near the groin or wrist –
local anesthetic is used to
numb the area where the cut is
made
• A very thin flexible tube
(catheter) is inserted into the
artery
• The catheter is carefully guided
to the area that's being
examined (such as the heart)
• A dye (contrast medium) is
injected into the catheter
• A series of X-rays are taken as
the dye flows through the blood
vessels

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Types of Angiography:
12
1.2 Angiography
• Coronary angiography – to check the
heart and nearby blood vessels
• Pulmonary angiography – to check
the blood vessels supplying the
lungs

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Types of Angiography:
13
• Cerebral angiography – to
check the blood vessels in and
around the brain
• Renal angiography – to check
the blood vessels supplying
the kidneys.
1.2 Angiography

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1.3 Lithotripsy
Lithotripsy is a noninvasive (the skin is not
pierced) procedure used to treat kidney
stones that are too large to pass through
the urinary tract.
Lithotripsy treats kidney stones by sending
focused ultrasonic energy or shock waves
directly to the stone first located with
fluoroscopy (a type of X-ray “movie”) or
ultrasound (high frequency sound waves).
1.3 Lithotripsy:

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Reasons for the procedure
The primary advantage of lithotripsy is
that it is completely non-invasive.
Lithotripsy is well suited to patients with
small kidney stones that can be easily
seen by x-ray.
When kidney stones become too large
to pass through the urinary tract, they
may cause severe pain and may also
block the flow of urine. An infection may
develop. Lithotripsy may be performed
to treat certain types of kidney stones in
certain locations within the urinary tract.
15
1.3 Lithotripsy

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2 Working principle
16
2 Working principle

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Fluoroscopy is a medical technique that based
on the use of X-ray in order to image the organs
of the body. This technique is done in order to
diagnose diseases and to guide physicians
during certain treatment procedures. With a
fluoroscope, when the beam that passes
through the body, it hits an image intensifier,
which increases the brightness of the image that
it can be viewed on a display screen.
2.1 Fluoroscopy
17
2.1 Fluoroscopy

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The image intensifier is an electronic device that converts the X-ray
beam intensity into a visible image suitable for capture by a video
camera and displayed on a video display monitor.
18
2.1 Fluoroscopy
The image intensifier also
contains a video camera
CCD or CMOS that
convert an optical image
into a digital image and
then into a video signal,
which can be seen on the
monitor, as an image.

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2.2 Angiography
19
2.2 Angiography
Angiography work based on the same principle of fluoroscopy,
but it is useful in diagnosing diseases related to blood vessels,
especially when studying blocked, damaged, or abnormal blood
vessels, while fluoroscopy is useful when watching the real-time
monitoring of different parts of the body and organs.

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2.2 Angiography
How X-ray angiography works
1. Emits X-rays from the X-ray
tube.
2. Limits the X-ray beams to
the patient’s body.
3. Process the detected data
into an image with reduced
noise
4. Displays the image on the
monitor in real time
5. Displays the image on the
monitor in real time
appropriate area
6. Captures X-rays passing
through
X-ray tube.

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Similarities Between Fluoroscopy and
Angiography
21
2.2 Angiography
• Both are X ray-based imaging techniques.
• In fact, angiography uses fluoroscopy for imaging.
• They are useful in both diagnosis and therapy.
• These techniques visualize internal structures.
• Contrast agents (dyes) are used in both techniques.
• several risks such as developing cancer in later life and tissue effects
are possible.

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2.2 Angiography
Differences Between Fluoroscopy and
Angiography
• Fluoroscopy is an imaging technique that generates live images of
different body parts, while angiography is an imaging technique that
visualizes the interior of blood vessels.
• Fluoroscopy is useful when watching the real-time monitoring of
different parts of the body and organs such as skeletal, digestive,
urinary, cardiovascular, respiratory, and reproductive systems.
• Angiography is useful in diagnosing diseases related to blood vessels.

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There are two types of lithotripsy:
2.3 Lithotripsy
23
2.3 Lithotripsy
1. Extracorporeal shock wave lithotripsy (ESWL)
It involves the use of high-energy shock waves that
pass through the body and are used to break up
kidney stones into small pieces like grains of sand.
Due to their small size, these pieces can pass from
the body with urine. ESWL treatment for stones
between 4 mm and 2 cm.

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The principle of work in ESWL lithotripsy:
24
2.3 Lithotripsy
High-energy shocks are generated and
focused on the stone, causing it to
fragment as tensile and shear forces
develop inside the stone and cavitation
occurs on its surface. Water or a
conducting gel couples the generator to
the patient.

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Types of Shock-Wave Generator in ESWL
lithotripsy:
Electrohydraulic original method
of shockwave generation (used in
the Dornier HM3) was
electrohydraulic, meaning that the
shockwave is produced via spark
gap technology. In an
electrohydraulic generator, a high-
voltage electrical current passes a
spark-gap electrode located within
a water-filled container.
25
2.3 Lithotripsy
1. Electrohydraulic Shock Wave
Generator (Spark Gap)

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Types of Shock-Wave
Generator in ESWL
lithotripsy
26
2.3 Lithotripsy
2. Electromagnetic Shock Wave Generator:
Electromagnetic generators employ a magnetic
field produced by sending an electric current
through a coil attached to thin metallic
membrane similar to a speaker cone. Shock waves
are produced by the movement of a metallic
membrane driven by an electromagnetic coil and
are focused by means of an acoustic lens on the
kidney stone located at the second focal point.

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Types of Shock-Wave
Generator in ESWL lithotripsy
3.Piezoelectric Shock Wave
Generator:
Piezoelectric generators employ a
spherical array of up to 4,000 ceramic
elements. Shock waves are generated
when short high-voltage pulses are
applied to the elements of the array.
27
2.3 Lithotripsy

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2- Intracorporeal lithotripters:
28
2.3 Lithotripsy
There are two types of lithotripsy:
Intracorporeal lithotripters are used to break up large
stones that the extracorporeal lithotripters cannot,
typically impacted stones in the upper ureters or those
located in the lower urinary tract. Although
intracorporeal lithotripsy is minimally invasive and
poses a lower risk than open surgical stone-removal
procedures, it poses a greater risk to the patient than
extracorporeal lithotripsy.

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After administration of an anesthetic, the surgeon
inserts a nephoscope (for percutaneous
lithotripsy) or an ureterorenoscope (for
transurethral lithotripsy) into the ureter and
guides it, with the aid of a fluoroscopy unit, so
that it is in intimate contact with the stone.
2- Intracorporeal lithotripters:
29
2.3 Lithotripsy

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Different methods of generating the
stone-shattering shock waves:
1. Laser lithotripsy:
The operator again visualizes the stone
through an ureteroscope, places the quartz
fibers of the probe directly against the stone
and activates the laser. The laser produces
pulses of light between 755 and 2,100 nm,
which cause a differential thermal expansion
of the stone that fragments it into 1-to-2-
millimeter pieces.
30
2.3 Lithotripsy

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2.Ultrasonic lithotripsy
Ultrasonic lithotripsy makes use of
mechanical vibration to break stones
into smaller fragments that may be
aspirated with specialized probes.
This method requires direct contact
between the probe and the stone.
31
2.3 Lithotripsy
Different methods of generating the stone-
shattering shock waves:

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Different methods of generating the stone-
shattering shock waves:
3.Electrohydraulic lithotripsy (EHL)
This type of lithotripsy uses electrical shock waves
to break down kidney stones so the smaller
pieces can pass through your urinary tract. EHL
is often done in conjunction with a Spyglass
procedure to break up large stones
endoscopically instead of performing surgery.
EHL requires general anesthesia
32
2.3 Lithotripsy

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3.
Benefits
& Risks
3. Benefits & Risks 33

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3.1 Fluoroscopy 34
3.1 Fluoroscopy
Risks:
• A slight risk of cancer from excessive
exposure to radiation. However, the benefit
of an accurate diagnosis far outweighs the
risk.
• radiation-induced injuries to the skin and
underlying tissues (“burns”)
• Occasional patients may have an allergic
reaction to the flavoring added to some
brands of barium oral contrast.
• Women should always inform their
radiologist or technologist if there is any
chance that they are pregnant.
Benefits:
• Abdominal fluoroscopy is a safe
and noninvasive procedure.
• The results of abdominal
fluoroscopy usually led to accurate
evaluation of the abdominal
region.
• No radiation remains in a patient’s
body after the examination.
• X-rays usually have no side effects
in the typical diagnostic range of
this exam.

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3.2 Angiography
35
3.2 Angiography
Benefits:
 Heart and vascular
angiography can
detect narrowing or
obstruction of blood
vessels allowing for
potentially corrective
therapy to be done.
 No radiation remains
in a patient's body
after heart and
vascular angiography.
Risks:
• A slight chance of cancer from excessive
exposure to radiation
• In patients who are at risk for kidney failure and
who already have borderline kidney functions;
administering iodinated contrast material could
potentially further damage kidney functions.
• Women should always inform their radiologist if
there is any possibility that they are pregnant.
• There is possible risk of serious allergic reaction
to contrast materials that contain iodine.
• possible risks related to this procedure are
injuries to blood vessel walls

10cm
3.3 Lithotripsy
Benefits:
• lithotripsy is effective
between 70 and 80
percent of the time. The
procedure is most
successful for patients
with kidney stones in the
upper part of the urinary
tract.
36
3.3 Lithotripsy
Risks:
• It is possible that the procedure
successfully breaks apart the stones,
but the pieces block the flow of urine
or remain inside the body, which
requires additional treatments.
• The procedure can cause bleeding
around the kidney and kidney
damage.

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4. Main Components
37
4. Main Components

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4.1 Fluoroscopy
38
4.1 Fluoroscopy

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4.2 Angiography
39
4.2 Angiography

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4.3 Lithotripsy
40
4.3 Lithotripsy

10cm 41
5. Maintenance and Calibration
5. Maintenance and
Calibration

10cm
5.1 Fluoroscopy
• Daily:
Damaged components, plates and warning.
• Weekly:
All cables and terminals
(damages/breakages).
Oil drippings and unusual noises in high
voltage generator.
• Half-yearly:
Operation of the arm movement limit
switch.
Accessories for the centering of the x-ray
group and the image acquisition unit
(marks, lock devices, contacts).
• Yearly:
Contact the technical after-sale service to
perform the constancy and reproducibility
tests, as indicated by IEC 61223-1 and IEC
61223-2- 11 standards, as well as the other
operating tests of the unit, as instructed in
the planned maintenance plan.
42
5.1 Fluoroscopy

10cm
5.2 Angiography
43
5.2 Angiography
Check Reason Frequency Check Reason Frequency
Controls and
indicators
All controls 6 months
Collision
sensors
Check that
applied
movement is
inhibited and
that an audible
alarm is
generated
6 months
All
visible/audible
indicators
6 months
Table
controls/move
ments
6 months
SID 6 months Oil level
Check oil level
and clean oil
filter
6 monthly
Shutter speed 6 months Earth (ground)
Check maximum
earth (ground)
of whole system
Yearly

10cm
5.2 Angiography
44
5.2 Angiography
Check Reason Frequency Check Reason Frequency
Image quality
FD AK check,
monitors and
stability
Yearly
Mechanical
•Counterweight
fasteners and cables
•All mechanical stops
(limits)
•Brakes and locks
•Grease/lubricate
Yearly
Allura Xper
FD20 series
system
Calibrate
(Velara generator)
Yearly
Stand motion Calibrate Yearly
End-stops
Check condition
(Look for damage)
Yearly Bearings
Check freedom from
dust, grease and oil
Yearly
PCBs and
racks
Ensure secure
fitting and check for
dust and corrosion
Yearly FD cooling
Check for presence
and readability of
warning label
Yearly

10cm
5.3 Lithotripsy
1. Test the internal energy meter.
2. Temperature sensor test.
3. Laser test.
4. Fan flow.
5. Check lock.
45
5.3 Lithotripsy

10cm 46
6. Common malfunctions
6. Common malfunctions
• The X-ray tube could be damaged or pitted
• The Image Intensifier might be damaged.
• Charger failure
• Hard drives may be full or need replacing
• Communication error
• Switches failing
• C-Arm lock up
• Insulation around the cables could be
degrading
• LOW contrast, no grid was used
• No Exposure

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7. Devices Specifications
47
7 Device Specification

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7.1 Most
Important Specifications
48
7.1 Most important specification

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7.2 Fluoroscopy Companies Comparison
50
Brand/Manufacturer Siemens Philips GE healthcare
Model Luminos Agile Max CombiDiagnost R90
Discovery*
RF180
Country of origin Germany Netherlands U.S
CE mark Yes N/A N/A
FDA clearance Yes N/A N/A
Certificate ISO 13485 N/A N/A
Reference of Technical
Configuration
Digital floor -mounted
patient-side fluoroscopy
system with 43*43 cm flat
detector for fluoroscopy and
general radiography
exposures
Complete with patient table
is a remote controlled
fluoroscopy system in
combination with high-end
digital radiography,
High quality images, a fully
digital workflow, dynamic
UNIQUE image processing and
excellent dose saving features

10cm 51
Over/under table tube
Under table
X-ray N/A N/A
Table geometry
Table hight 65 cm 62 cm – 142 cm Min:47cm
Table dimensions 210 cm*80 cm N/A 246 x 80 cm
Tilt angle +90 to-20 -90°/+90° + 90° to – 90°
Maximum patient weight 275 kg 284 kg 266 kg
Source to image distance N/A 113 cm to 183 cm 180 cm
Imaging Tower
Longitudinal movement 110 cm N/A 305 cm
Lateral movement 28 cm N/A ±17,5 cm
Vertical movement 75 cm to 185 cm N/A N/A
Model Luminos Agile Max CombiDiagnost R90
Discovery*
RF180

10cm 52
Controls
Comprehensive tableside
contols for all system
movements.system control
console and high performance
PC with flat panel display. Foot
switch for fluoroscopy and
radiography acquisition
N/A N/A
Table/ tower
movement
Tableside controls and system
control console
N/A N/A
Fluoroscopy Yes N/A N/A
Radiography Yes N/A N/A
Removable grid Yes N/A N/A
Model Luminos Agile Max
CombiDiagnost
R90
Discovery*
RF180

10cm 53
Detector
Detector type
Flat detector technology
(ASI with CSU scintillator
Flat detector
Flat detector
Amorphous silicon
Detector size 43*43 cm 43*43 cm 43*43 cm
Field size
Flat detector size 43*43
cm with input fields
42*42.6 cm, 30*30 cm,
22*22 cm ,15*15 cm
N/A
Nominal: 43 x 43 cm
Zoom 1: 30 x 30 cm
Zoom 2: 20 x 20 cm
Zoom 3: 15 x 15 cm
Acquisition matrix size Fixed:2840*2874 pixels
Fixed:2840*2874
pixels
N/A
Acquisition bit depth 16 bits N/A 16 bits
Tube
Focal spot
Anode heat storage
capacity
N/A 300 kHU N/A
CombiDiagnost
R90
Discovery* RF180

10cm 54
Power 65 kW 65kW ,80kW optional 65kW ,80kW
Exposure techniques N/A
• Manual: kV-mAs or kV-mA-s •
Automatic Exposure Control
(AEC)
• Intelligent Exposure (IQX),
In-Pulse controlled
• Automatic kV reduction
techniques
N/A
Fluoroscopy techniques N/A
Pulsed fluoroscopy (PF), in-pulse
controlled
• Grid-controlled fluoroscopy
(GCF), in-pulse controlled
N/A
Maximum voltage N/A 150kV N/A
Generator
Model
Luminos
Agile Max
CombiDiagnost R90 Discovery* RF180

10cm 55
Tube voltage exposure 40 – 150 kV 40 – 150 kV 40 – 150 kV
Radiographic mA range 1mA to 800 mA 0.1 – 1000 mAs
Tube voltage
Fluoroscopy
40 – 110 kV 40 – 125 kV 40 – 125 kV
Fluoroscopic mA range 0.2 mA to 23 mA N/A 0.5 – 10 mA
Fluoroscopy
Pulse rate Max 30 f/s N/A 15 img/s
User selectable
filtration
Yes, automatic filtration N/A N/A
Additional filtration 0.1,0.2,0.3 mmCu N/A N/A
Maximum acquisition
matrix size
2840*2874 pixels N/A
43 x 43 cm = 960 x 960
30 x 30 cm=1024*1024
20 x 20 cm=672*672 15
x 15 cm =1024*102
CombiDiagnost
R90
Discovery* RF180

10cm 56
Acquisition bit depth 16 bits N/A N/A
Radiography N/A N/A N/A
Acquisition matrix size Fixed:2840*2874 pixels N/A 2880 x 2880
Acquisition bit depth 16 bits N/A 16 bits
Digital detector
1*fixed detector at
patient table
N/A N/A
Function
Both Radiographic
exposure and digital
fluoroscopy
N/A N/A
Price N/A 156001$ 125000$
Model Luminos Agile Max CombiDiagnost R90 Discovery* RF180

10cm 57
8.References
● https://www.fda.gov/radiation-emitting-
products/medical-imaging/medical-x-ray-
imaging#description
● https://www.imagewisely.org/Imaging-
Modalities/Fluoroscopy/Modern-Imaging-
Systems
● https://www.hopkinsmedicine.org/health/trea
tment-tests-and-therapies/fluoroscopy-
procedure
● https://www.nhs.uk/conditions/angiography/
● https://www.hopkinsmedicine.org/health/trea
tment-tests-and-therapies/lithotripsy
● https://www.differencebetween.com/what-is-
the-difference-between-fluoroscopy-and-
angiography/
● https://radiologykey.com/fluoroscopy-2/
● https://www.brainkart.com/article/Anesthesia-
for-Lithotripsy_27075/
● https://www.sciencedirect.com/topics/medicine
-and-dentistry/ultrasonic-lithotripsy
● https://www.sciencedirect.com/topics/medicine
-and-dentistry/lithotripsy
● https://www.nejm.org/doi/full/10.1056/nejmct11
03074
● Fluoroscopy | FDA
● Advantages and Disadvantages of Lithotripsy -
Facty Health
● Lithotripsy: Purpose, Procedure, and Risks
(healthline.com)
● https://biologyisu.wordpress.com/how-it-
works-2/
8.References

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