Digital fluoroscopy uses a digital x-ray system to create dynamic images using an area x-ray beam. The main difference from conventional fluoroscopy is that images are digitized. It uses pulsed progressive fluoroscopy with short exposures to reduce patient dose while maintaining image quality. Images are detected using a charge-coupled device (CCD) instead of a TV camera, offering benefits like higher resolution, sensitivity, and stability. Flat panel detectors composed of cesium iodide and amorphous silicon pixels provide a more uniform, higher quality image than traditional image intensifiers. Overall, digital fluoroscopy improves image quality and lowers patient radiation exposure.

1. DIGITAL FLUOROSCOPY
By Oliver
Medical Physicist

2. DIGITAL
FLUOROSCOPY
• Is a digital x-ray imaging
system that produces
dynamic images obtained
with an area x-ray beam.
• The difference between
conventional fluoroscopy and
DF is the nature of the image
and the manner in which it is
digitized

3. Digital Fluoroscopy

4. Pulsed progressive
fluoroscopy
• During DF, the under-table x-ray tube actually operates in
the radiographic mode.
• Tube current is measured in hundreds of mA instead of less
than 5 mA, as in image-intensifying fluoroscopy.
• Pulsed progressive fluoroscopy is used in DF
• Short exposures are required because longer ones increase
patient dose however, longer exposures may be necessary
to ensure low noise and good image quality.
• The time required for the x-ray tube to be switched on and
reach selected levels of kilovolt peak (kVp) and mA is called
the interrogation time
• The time required for the x-ray tube to be switched off is
the extinction time
• These times must be less than 1ms
• Fraction the x-ray tube is energized is duty cycle

5. Image Receptor- Charge-Coupled Device
• Pulse progressive fluoroscopy is
essential for reducing patient
radiation dose and should be
routinely used.
• A major change from conventional
fluoroscopy to DF is the use of a
charge-coupled device (CCD)
instead of a TV camera tube.
• The sensitive component of a CCD
is a layer of crystalline silicon.
When this silicon is illuminated,
electrical charge is generated,
which is then sampled, pixel by
pixel, and manipulated to produce
a digital image.

6. Charged coupled
Device
• The CCD is mounted on the output phosphor of the
image-intensifier tube and is coupled through
fiberoptics.
• With a lens-coupled CCD, a sample of light is
measured and is used to drive the automatic
brightness stabilization (ABS) system.

7. Advantage of CCDs
• Advantage of CCDs in most applications, such as a digital camera, is
their small size and ruggedness.
• The spatial resolution of a CCD is determined by its physical size
and pixel count.
• The CCD has greater sensitivity to light (detective quantum
efficiency) and a lower level of electronic noise than a television
camera tube.
• The results are a higher signal-to-noise ratio (SNR) and better
contrast resolution. These characteristics also result in substantially
lower patient radiation doses.
• The response of the CCD to light is very stable. Warm-up of the
CCD is not required. Neither image lag nor blooming is present. It
has essentially an unlimited lifetime and requires no maintenance.

8. Linear response
Helpful for digital subtraction angiography
(DSA) and results in improved dynamic range
and better contrast resolution.

9. Flat panel image receptor
• Composed of cesium iodide
(CsI)/amorphous silicon (a-Si)
pixels. The needle-like structures
help direct light toward the
photodiode located below
• The FPIR is much smaller and
lighter and is manipulated more
easily than an image intensifier.
• The image intensifier is limited by
non-uniform spatial resolution and
contrast resolution from the centre
to the periphery of the circular
image.
• Veiling glare and pincushion
distortion increase with age on an
image intensifier. The response of
an FPIR is uniform over the entire
receptor and does not degrade
with age.

10. Flat panel detector

11. Flat panel display
• Replaces the cathode ray tube
• They are light in weight, easy to see, and can be readily mounted
suspended in an angiographic room