X-ray image intensifier

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An X-ray image intensifier (XRII) is an image intensifier that converts X-rays into visible light at higher intensity than the more traditional fluorescent screens can. Such intensifiers are used in X-ray imaging systems (such as fluoroscopes) to allow low-intensity X-rays to be converted to a conveniently bright visible light output. The device contains a low absorbency/scatter input window, typically aluminum, input fluorescent screen, photocathode, electron optics, output fluorescent screen and output window. These parts are all mounted in a high vacuum environment within glass or, more recently, metal/ceramic. By its intensifying effect, It allows the viewer to more easily see the structure of the object being imaged than fluorescent screens alone, whose images are dim. The XRII requires lower absorbed doses due to more efficient conversion of X-ray quanta to visible light. This device was originally introduced in 1948. [1]

Contents

Operation

Schematic of an X-ray image intensifier XiiSchematic.jpg
Schematic of an X-ray image intensifier

The overall function of an image intensifier is to convert incident x-ray photons to light photons of sufficient intensity to provide a viewable image. This occurs in several stages. The input window is convex is shape, made up of aluminium to minimise the scattering of X-rays. The window is 1 mm in thickness. Once X-rays pass through the aluminium windows, it encounters input phosphor that converts X-rays into light photons. The thickness of input phosphor range from 300 to 450 micrometres reach a compromise between absorption efficiency of X-rays and spatial resolution. Thicker input phosphor has higher absorption efficiency but poor spatial resoution and vice versa. Sodium activated Caesium Iodide is typically used due to its higher conversion efficiency thanks to high atomic number and mass attenuation coefficient, when compared to zinc-cadmium sulfide. The input phosphor are arranged into small tubes, to allow photons to pass through the tube, without scattering, this improving the spatial resolution. [2] The light photons are then converted to electrons by a photocathode. The photocathode is made up of antimony caesium, which is to match the photons produced from input phosphor, thus maximise the efficiency of producing photoelectrons. The photocathode has a thickness of 20 nm with absorption efficacy of 10 to 15%. [2]

A potential difference (25-35 kilovolts) created between the anode and photocathode then accelerates these photoelectrons while electron lenses focus the beam down to the size of the output window. The output window is typically made of silver-activated zinc-cadmium sulfide and converts incident electrons back to visible light photons. [2] At the input and output phosphors the number of photons is multiplied by several thousands, so that overall there is a large brightness gain. This gain makes image intensifiers highly sensitive to X-rays such that relatively low doses can be used for fluoroscopic procedures. [3] [4] [5] [6]

History

X-ray image intensifiers became available in the early 1950s and were viewed through a microscope. [7]

Viewing of the output was via mirrors and optical systems until the adaption of television systems in the 1960s. [8] Additionally, the output was able to be captured on systems with a 100mm cut film camera using pulsed outputs from an X-ray tube similar to a normal radiographic exposure; the difference being the II rather than a film screen cassette provided the image for the film to record.

The input screens range from 15–57 cm, with the 23 cm, 33 cm and 40 cm being among the most common. Within each image intensifier, the actual field size can be changed using the voltages applied to the internal electron optics to achieve magnification and reduced viewing size. For example, the 23 cm commonly used in cardiac applications can be set to a format of 23, 17, and 13 cm. Because the output screen remains fixed in size, the output appears to "magnify" the input image. High-speed digitalisation with analogue video signal came about in the mid-1970s, with pulsed fluoroscopy developed in the mid-1980s harnessing low dose rapid switching X-ray tubes. In the late 1990s image intensifiers began being replaced with flat panel detectors (FPDs) on fluoroscopy machines giving competition to the image intensifiers. [9]

Clinical applications

"C-arm" mobile fluoroscopy machines are often colloquially referred to as image intensifiers (or IIs), [10] however strictly speaking the image intensifier is only one part of the machine (namely the detector).

Fluoroscopy, using an X-ray machine with an image intensifier, has applications in many areas of medicine. Fluoroscopy allows live images to be viewed so that image-guided surgery is feasible. Common uses include orthopedics, gastroenterology and cardiology. [11] Less common applications can include dentistry. [12]

Configurations

C-arm of a mobile X-ray unit containing an image intensifier (top) Mobile X-ray image intensifier.JPG
C-arm of a mobile X-ray unit containing an image intensifier (top)

A system containing an image intensifier may be used either as a fixed piece of equipment in a dedicated screening room or as mobile equipment for use in an operating theatre. A mobile fluoroscopy unit generally consists of two units, the X-ray generator and image detector (II) on a moveable C-arm, and a separate workstation unit used to store and manipulate the images. [13] The patient is positioned between the two arms, typically on a radiolucent bed. Fixed systems may have a c-arm mounted to a ceiling gantry, with a separate control area. Most systems arranged as c-arms can have the image intensifier positioned above or below the patient (with the X-ray tube below or above respectively), although some static in room systems may have fixed orientations. [14] From a radiation protection standpoint, under-couch (X-ray tube) operation is preferable as it reduces the amount of scattered radiation on operators and workers. [15] [16] Smaller "mini" mobile c-arms are also available, primarily used to image extremities, for example for minor hand surgery. [17]

Flat panel detectors

Flat Detectors are an alternative to Image Intensifiers. The advantages of this technology include: lower patient dose and increased image quality because the X-rays are always pulsed, and no deterioration of the image quality over time. Despite FPD being at a higher cost than II/TV systems, the noteworthy changes in the physical size and accessibility for the patients is worth it, especially when dealing with paediatric patients. [9]

Feature comparison of II/TV and FPD Systems

Feature [9] Digital Flat PanelConventional II/TV
Dynamic rangeWide, about 5,000:1Limited by TV, about500:1
Geometric distortionNonePin-cushion and ‘S-distortion
Detector size (bulk)Thin profileBulky, significant with large FOV
Image area FOV41 x 41 cm40 cm diameter (25% less area)
Image qualityBetter at high doseBetter at low dose

See also

Related Research Articles

X-ray Form of short-wavelength electromagnetic radiation

An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz (30×1015 Hz to 30×1018 Hz) and energies in the range 145 eV to 124 keV. X-ray wavelengths are shorter than those of UV rays and typically longer than those of gamma rays. In many languages, X-radiation is referred to as Röntgen radiation, after the German scientist Wilhelm Conrad Röntgen, who discovered it on November 8, 1895. He named it X-radiation to signify an unknown type of radiation. Spellings of X-ray(s) in English include the variants x-ray(s), xray(s), and X ray(s). The most familiar use of x-rays is checking for fractures (broken bones), but x-rays are also used in other ways. For example, chest x-rays can spot pneumonia. Mammograms use x-rays to look for breast cancer.

Radiography Imaging technique using ionizing and non-ionizing radiation

Radiography is an imaging technique using X-rays, gamma rays, or similar ionizing radiation and non-ionizing radiation to view the internal form of an object. Applications of radiography include medical radiography and industrial radiography. Similar techniques are used in airport security. To create an image in conventional radiography, a beam of X-rays is produced by an X-ray generator and is projected toward the object. A certain amount of the X-rays or other radiation is absorbed by the object, dependent on the object's density and structural composition. The X-rays that pass through the object are captured behind the object by a detector. The generation of flat two dimensional images by this technique is called projectional radiography. In computed tomography an X-ray source and its associated detectors rotate around the subject which itself moves through the conical X-ray beam produced. Any given point within the subject is crossed from many directions by many different beams at different times. Information regarding attenuation of these beams is collated and subjected to computation to generate two dimensional images in three planes which can be further processed to produce a three dimensional image.

Radiology Branch of Medicine

Radiology is the medical discipline that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography, but today it includes all imaging modalities, including those that use no electromagnetic radiation, as well as others that do, such as computed tomography (CT), fluoroscopy, and nuclear medicine including positron emission tomography (PET). Interventional radiology is the performance of usually minimally invasive medical procedures with the guidance of imaging technologies such as those mentioned above.

Scintillation counter Measurement device

A scintillation counter is an instrument for detecting and measuring ionizing radiation by using the excitation effect of incident radiation on a scintillating material, and detecting the resultant light pulses.

X-ray generator Machine that generates Xrays

An X-ray generator is a device that produces X-rays. Together with an X-ray detector, it is commonly used in a variety of applications including medicine, X-ray fluorescence, electronic assembly inspection, and measurement of material thickness in manufacturing operations. In medical applications, X-ray generators are used by radiographers to acquire x-ray images of the internal structures of living organisms, and also in sterilization.

Fluoroscopy Production of an image when X-rays strike a fluorescent screen

Fluoroscopy is an imaging technique that uses X-rays to obtain real-time moving images of the interior of an object. In its primary application of medical imaging, a fluoroscope allows a physician to see the internal structure and function of a patient, so that the pumping action of the heart or the motion of swallowing, for example, can be watched. This is useful for both diagnosis and therapy and occurs in general radiology, interventional radiology, and image-guided surgery.

Photocathode

A photocathode is a surface engineered to convert light (photons) into electrons using the photoelectric effect. Photocathodes are important in accelerator physics where they are utilised in a photoinjector to generate high brightness electron beams. Electron beams generated with photocathodes are commonly used for free electron lasers and for ultrafast electron diffraction. Photocathodes are also commonly used as the negatively charged electrode in a light detection device such as a photomultiplier or phototube.

An image intensifier or image intensifier tube is a vacuum tube device for increasing the intensity of available light in an optical system to allow use under low-light conditions, such as at night, to facilitate visual imaging of low-light processes, such as fluorescence of materials in X-rays or gamma rays, or for conversion of non-visible light sources, such as near-infrared or short wave infrared to visible. They operate by converting photons of light into electrons, amplifying the electrons, and then converting the amplified electrons back into photons for viewing. They are used in devices such as night-vision goggles.

Photodetector Sensors of light or other electromagnetic energy

Photodetectors, also called photosensors, are sensors of light or other electromagnetic radiation. There is a wide variety of photodetectors which may be classified by mechanism of detection, such as photoelectric or photochemical effects, or by various performance metrics, such as spectral response. Semiconductor-based photodetectors typically photo detector have a p–n junction that converts light photons into current. The absorbed photons make electron–hole pairs in the depletion region. Photodiodes and photo transistors are a few examples of photo detectors. Solar cells convert some of the light energy absorbed into electrical energy.

Caesium iodide Chemical compound

Caesium iodide or cesium iodide is the ionic compound of caesium and iodine. It is often used as the input phosphor of an X-ray image intensifier tube found in fluoroscopy equipment. Caesium iodide photocathodes are highly efficient at extreme ultraviolet wavelengths.

Digital radiography is a form of radiography that uses x-ray–sensitive plates to directly capture data during the patient examination, immediately transferring it to a computer system without the use of an intermediate cassette. Advantages include time efficiency through bypassing chemical processing and the ability to digitally transfer and enhance images. Also, less radiation can be used to produce an image of similar contrast to conventional radiography.

Industrial radiography

Industrial radiography is a modality of non-destructive testing that uses ionizing radiation to inspect materials and components with the objective of locating and quantifying defects and degradation in material properties that would lead to the failure of engineering structures. It plays an important role in the science and technology needed to ensure product quality and reliability.

Radioactivity in the life sciences

Radioactivity is generally used in life sciences for highly sensitive and direct measurements of biological phenomena, and for visualizing the location of biomolecules radiolabelled with a radioisotope.

Projectional radiography Formation of 2D images using X-rays

Projectional radiography, also known as conventional radiography, is a form of radiography and medical imaging that produces two-dimensional images by x-ray radiation. The image acquisition is generally performed by radiographers, and the images are often examined by radiologists. Both the procedure and any resultant images are often simply called "X-ray". Plain radiography or roentgenography generally refers to projectional radiography. Plain radiography can also refer to radiography without a radiocontrast agent or radiography that generates single static images, as contrasted to fluoroscopy, which are technically also projectional.

Photofluorography is photography of X-ray images from a fluorescent screen. It is commonly used in some countries for chest X-ray screening, e.g. to diagnose tuberculosis.

Photostimulated luminescence (PSL) is the release of stored energy within a phosphor by stimulation with visible light, to produce a luminescent signal. X-rays may induce such an energy storage. A plate based on this mechanism is called a photostimulable phosphor (PSP) plate and is one type of X-ray detector used in projectional radiography. Creating an image requires illuminating the plate twice: the first exposure, to the radiation of interest, "writes" the image, and a later, second illumination "reads" the image. The device to read such a plate is known as a phosphorimager.

Automatic exposure control

Automatic Exposure Control (AEC) is an X-ray exposure termination device. A medical radiographic exposure is always initiated by a human operator but an AEC detector system may be used to terminate the exposure when a predetermined amount of radiation has been received. The intention of AEC is to provide consistent x-ray image exposure, whether to film, a digital detector or a CT scanner. AEC systems may also automatically set exposure factors such as the X-ray tube current and voltage in a CT.

Flat-panel detector Class of solid-state x-ray digital radiography devices

Flat-panel detectors are a class of solid-state x-ray digital radiography devices similar in principle to the image sensors used in digital photography and video. They are used in both projectional radiography and as an alternative to x-ray image intensifiers (IIs) in fluoroscopy equipment.

X-ray detector Instrument that can measure properties of X-rays

X-ray detectors are devices used to measure the flux, spatial distribution, spectrum, and/or other properties of X-rays.

Photon counting Counting photons using a single-photon detector

Photon counting is a technique in which individual photons are counted using a single-photon detector (SPD). A single-photon detector emits a pulse of signal for each detected photon, in contrast to a normal photodetector, which generates an analog signal proportional to the photon flux. The number of pulses is counted, giving an integer number of photons detected per measurement interval. The counting efficiency is determined by the quantum efficiency and the system's electronic losses.

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