0:01

Modern fluoroscopy equipment systems have various

0:05

type of configuration.

0:08

They can be

0:09

under X-ray tube table, under table X-ray tube, which is

0:13

usually in a typical radiology department, which is

0:16

radiography or fluoroscopy under the table X-ray tube.

0:21

Or the fluoroscopy system can be over the X-ray tube.

0:25

Then you have the fixed C-arm positioner.

0:28

It can be mono or a biplane system. Then you have the

0:32

mobile C-arm and, of course, the mini C-arm

0:35

also. So here is the capturing of

0:39

four different systems

0:41

showing the configuration of the equipment systems.

0:45

The most common fluoroscopy system in radiology is general

0:49

under table system.

0:51

Whereas if you move into interventional area,

0:55

such as in radiology or in cardiology, you're going to see this type of a

0:59

beastly C-arm

1:01

planted to the ground, but the C-arm shape can be rotated very easily.

1:05

Then there are system with a biplane system.

1:08

But these days, most ubiquitous fluoroscopy system in the hospital

1:13

is the mobile C-arm, which can be moved around and more

1:16

generally used in the surgical suite where it can be brought in and out

1:20

when they're doing the surgery.

1:22

So let's examine some of the typical X-ray equipment configuration.

1:28

This is the radiography fluoroscopy system, which has an under the table

1:32

X-ray tube.

1:33

When I say these type of suites or systems has both

1:37

radiography and fluoroscopy, because you can see in this room there is

1:41

a X-ray system independently. So when you

1:45

don't have to use the fluoroscopy, the room is used for taking just

1:49

X-ray or plain X-rays.

1:51

When it is used as a fluoroscopy mode, the application are

1:54

typically for GI, for GU, and

1:58

myelogram, arthrography, and even interventional.

2:03

The features are as follows. You have the X-radiography

2:07

with overhead X-ray tube, as you can show here.

2:10

Then you have a table which can be tilted based on the

2:14

operator's desire. Then you have an X-ray tube

2:17

underneath the table,

2:19

quite shielded with this particular table.

2:23

You have the image receptor here, which is the intensifier here,

2:27

which allow the user to adjust the collimation,

2:31

or you can do a fluoro recording or a

2:36

spot film device which has a photo spot and digital photo spot.

2:40

And this is the workhorse of most radiology department

2:44

in the world for a lot of the simple fluoroscopy procedure.

2:49

When it gets complicated, when you want to do longer and longer, that's when

2:53

we move into the larger side C-arm.

2:57

Another type of configuration is over the table X-ray tube.

3:01

This system you are seeing less and less these days.

3:05

Here the configuration here is the X-ray table, X-ray tube, but

3:09

underneath is the image receptor.

3:12

Let's say it has the image intensifier.

3:15

This is typically was used in urology, where the urologist used to

3:19

sit at the end of the table and position the X-ray tube to hit the

3:22

pelvic area for examining that area and the receptor.

3:27

So the radiography with the same X-ray tube, but it has an angling

3:31

X-ray tube and can be remotely controlled.

3:35

But however, there's one of the drawback of this particular system was there is a

3:38

lot of increased personal dose for the physician working in the system.

3:43

These days, we see less and less of this configuration.

3:46

But this is a biplane position. This you

3:50

typically do not see in the radiology department, but you are

3:54

seeing in interventional radiology or interventional

3:57

cardiology departments. And it is typically used for

4:01

radiography and angiography procedure,

4:04

and both in cardiology, neurointerventional, or

4:08

regular radiology interventional.

4:10

The feature is it has a C-arm sealed to the

4:14

floor

4:16

on which is there is a C-arm system here, or

4:20

it has a mounted arm where this whole

4:24

carriage is carrying another system.

4:27

So this is one system with an X-ray tube, image receptor,

4:30

X-ray tube, and the image receptor, and they can

4:34

be simultaneously operated to give a biplane

4:38

view for the user.

4:41

The most commonly used in the hospital these days,

4:45

outside of the radiology and in the radiology, is the mobile C-arm.

4:50

To give you a scale at Johns Hopkins, we have more than 60

4:53

mobile C-arm in the hospital, predominantly outside

4:57

radiology, used for lot of routine care around the

5:01

patient by orthopedics, urologist,

5:05

and everywhere, and then mostly in the surgical suite

5:08

also. So as you can see here, again, it's a compact system

5:13

which can be wheeled to the bed of the table, and that's why

5:17

the shape C is to insert it very closely into the patient

5:20

bed. There is a self-contained unit, which is a unit also with

5:24

the monitors, so you can see the X-rays

5:28

fluoroscopy images when it's operating.

5:32

These days, some of the image receptors are replaced by a flat panel

5:35

detector.

5:37

The principle behind is all the same.

5:41

One of the other type of equipment configuration of fluoroscopy is called

5:45

mini C-arm, which operates at a microampere rate.

5:49

These mini C-arms can go from the size here is about

5:53

two inches or four inches, all the way up to six-inch image

5:57

receptor.

5:58

And they are predominantly used by hand surgeons or

6:02

for pediatric cases for hand surgery or extremity surgery and

6:06

everything, and that's why you commonly do not see

6:10

in the radiology department, but more so in the operating area

6:14

by the orthopedics, hand surgeons, and so forth.

6:18

The application is mostly used for extremity.

6:21

The extremity's thickness is small, so therefore you don't need too much

6:25

X-ray output, and the exposure is also very small.

6:29

But all the radiation protection requirement also apply

6:33

for the mini C-arm, too.

6:36

These days, most of the interventional rooms are coming with a

6:40

biplane system or a single plane system,

6:43

and also with a CT scanner in place in the room.

6:47

Here is photograph of one such IR suite at Hopkins

6:51

here, which has a fluoroscopy and a

6:54

CT scanner in the suite so that the

6:57

fluoroscopist who are doing an interventional procedure can move the

7:01

table to the CT area and get a CT without having to move the

7:05

patient.

7:07

Then you might be interested in how this C-arm is inside an MR suite.

7:12

And because of that, there are way which can be brought

7:16

inside an MR suite. However, it has to be

7:20

tethered to the wall, and it cannot move beyond this

7:23

particular area, as you can see here.

7:25

Otherwise, it can be sucked into the gantry.

7:28

But it is also used outside, like in a place.