CT fluoroscopy1 (1).pptx

this slide sharer contents are basic principle of CT fluoroscopy , software and hardware parts of equipment and image aqua cation and radiation dose comparison and videos related to equipment .

1. CT Fluoroscopy VANI PUSHPA M 210531027

2. OVERVIEW INTRODUCTION HISTORY BASIC PRINCIPLE TOUCH INTERFACE PANEL APPLICATIONS ADVANTAGES DISADVANTAGES TECHNICAL CONSIDERATION RADIATION DOSE CONCLUSION

3. BASIC PRINCIPLE : CT fluoroscopy combines the cross-sectional image targeting provided by CT with the real-time imaging, tracking and movement perception of fluoroscopy for interventional procedures. It allows continuous update of images at a fixed position and is commonly used for CT-guided biopsies and fluid drainages . Computed tomography (CT) fluoroscopy combines the conventional advantages of both CT  and  fluoroscopy and has an important role in image-guided interventions where real-time imaging is required. REF: https ://doi.org/10.53347/rID-62860

4. HISTORY The first scanner with CT fluoroscopic capability was developed in 1993 by Dr. Katada FDA approved the use of CTF in 199 5 . Since its introduction , real time CT has been used for optimization of scan timing in contrast studies, as well as for guidance in biopsy or drainage procedures. https://thancguide.org/2021/03/the-journey/patients-journey/a-surprising-new-imaging-technique-fluoroscopic-ct-scanning

5. IMPORTANCE : Display of constantly updated images produced by continuous rotation of CT tube Couch position controlled by operator Generally performed at same KV, but lower mA than conventional CT scanning 120kV , 50mA for CT fluoroscopy 120kV, 200-300mA for conventional CT Ref:CT History (slideshare.net)

6. What equipment do I need for interventional radiology? CT fluoroscopy can be an excellent tool for reducing radiation dose and saving time on fluoroscopy procedures It also provides substantial dose reduction over conventional CT guidance for procedures like lesion biopsy and drainage. Ref:WHAT EQUIPMENT DO I NEED FOR CT FLUOROSCOPY? By:  Paul Crawford  on Oct 24, 2020 10:41:00 AM

7. CT fluoro is enabled through a combination of A software suite and A set of hardware REF: https :// info.blockimaging.com

8. A Set Of Hardware Exposure control switch (foot pedal or console/table-mounted joystick) Table movement controls (foot pedal or console/table-mounted joystick) Output review monitor(s) Monitor suspension (wall mounting hardware or ceiling-mounted boom)

9. How it works? Activation of touch interface panel Setting the couch speed and gantry position Setting the target Move in / Move out Activate laser Scan Fine Tuning with joystick Image or series review

10. SOFTWARE SUITE Fluoroscopy software suite of real time CT is dependent on following factors : Fast continuous scanning Fast image reconstruction Real time image display REF:http ://www.impactscan.org/slides/ctfluoroscopy/sld005.htm

11. FAST CONTINUOUS SCANNING The continuous scanning is possible because of Slip Ring Technology, with no interscan delay for unwinding of connecting cables. It thus reduces the scan time also and subsequently helps decrease the patient dose SYSTEM REQUIRMENTS : Slip rings for continuous scanning Fast tube rotation (1s or less)>>some newer systems have 0.5s rotation High heat capacity tube to allow extended scanning times if necessary

12. FAST IMAGE RECONSTRUCTION Fast image reconstruction, capable of providing upwards of 6-12 frames per second . At any given time, it provides 6 real time images ,that constitute a frame. Like, for 1 rotation of CT (360°) takes about 1 second, and in every 60° one image is produced. Therefore six images are produced for one gantry rotation. After one rotation in one second , the CT performs the second rotation and produces the seventh real time image. Now, this image is added and the 1 st image is discarded .Thus 6 images or frames are obtained at a time. Sometimes motion artefacts may be seen on the images and appear as streaks , however these do not restrict the visualisation of important structure.

13. REAL TIME IMAGE DISPLAY The data is collected on a defined matrix size of (256×256), which is then interpolated to a larger matrix (1024×1024) for better resolution. Images are subsequently displayed on the monitor kept in the operating room on the Cine mode with a frame rate of 6-12 per second.

14. APPLICATION B iopsies N eedle placement Fluid collection Aspiration Drainage PCNL Arthrography Nerve root blocks Vertebroplasty PCN

15. HOW IS IT USEFUL IN INTERVENTIONAL PROCEDURES ? Low MillIampher Technique for reduction in radiation dose. Reduction of procedure time. Quick Check Method Real Time Imaging Dedicated High Speed Array Processor Potential for increased procedure effeciency and accuracy leading to higher diagnostics yeild .

16. ADVANTAGES Overlapping structures can be removed, providing accurate spatial information Real-time display of images Consequent reduction in complications through finer needle control Reduced procedure time Increased operator confidence

17. DISADVANTAGES Large radiation doses to both patient and operator. Limited FOV / scanning range. Poor image quality due to low mA , because of the appearance of noise. Increased investment in more powerful hardware and specialized software needed.

18. Why your doctor my recommend a flouroscopic CT scan over other forms of imaging ? The Doctor may want to obtain highly accurate imaging They may wish to provide the patient with shorter intervention time which may decrease the radiation exposure Real time view of the body may give the doctor more information to make better decisions https://thancguide.org/2021/03/the-journey/patients-journey/a-surprising-new-imaging-technique-fluoroscopic-ct-scanning

19. TECHNICAL CONSIDERATIONS Video monitor will need to be displayed in the scanning room An operator panel is required in the scanning room – with controls available for table movement, gantry lift, laser light control and fluoroscopic factors. Exposures will usually be activated using a footswitch Involves an x-ray tube current of 30-50 ma Need for additional beam filtration to decrease  patient dose exposure. Multislice machines have finer z-axis resolution. CT fluoroscopy requires  special techniques for image reconstruction, due to the need for rapid imaging.

20. Radiation dose considerations in CT fluoroscopy Manufacturer / Model CT Flouro System KV / ma Settings Rotation Time (s) Patient Skin Dose Rate ( mGy /s) IGE HiSpeed CT/i Smart View 120 / 50 0.8 / 1.0 3.2 Picker UltraZ CCT / BolusPro 120 / 30 1 4.1 Siemens Somaton CARE Vision 120 / 50 0.75 / 1 4 .0 Toshiba Asteion* Aspire CI 120 / 50 0.75 / 1 3.3 REF: https ://doi.org/10.53347/rID-62862

21. DOSE COMPARSION: CONVETIONAL VS CTF MEAN DOSE/ EQUIPMENT Conventional CT Biopsy CTF Biopsy Conventional CT Drain CTF Drain Mean Skin Dose( mGy ) 300 430 400 220 Mean Effective Dose ( mGy /s) 2.5 3.5 3.2 1.5 REF: https ://doi.org/10.53347/rID-62862

22. CONCLUSION: CT fluoroscopy is a recently developed acquisition mode that allows faster imaging reconstruction, near continuous image update and convenient in room table control and image viewing during procedure . A cceptable radiation dose rate to patient and operator, is user friendly and guides interventional procedures with rapidity . Operators have to adopt techniques that will minimize the risk of putting their fingers in the beam

23. Reference: https :// doi.org/10.53347/rID-62862 https:// thancguide.org/2021/03/the-journey/patients-journey/a-surprising-new-imaging-technique-fluoroscopic-ct-scanning https :// doi.org/10.53347/rID-62860 http :// www.impactscan.org/slides/ctfluoroscopy/sld005.htm https :// info.blockimaging.com

24. Q&A What are the Basic principle of CT Fluoroscopy? Technique in CT Fluoroscopy? Fast continuous scanning possible by?

25. Thanks u for great opportunity