MAIN FEATURES Fluoroscopy unit Dirty utility space adjoining

MAIN FEATURES Fluoroscopy unit Dirty utility space adjoining the examination space Scrub sink with hot and cold water Surveillance X ray control (10 m 2) Storage space, apron rack and shelves for all equipment Surgical ceiling mounted lights Patient preparation space/room

Fluoroscopy history Popular Science: July 1939

Fluoroscopy unit Motion features • C or U arm which can rotate in axial and sagittal planes • Angles of rotation must be displayed on the monitor • Ability to vary source detector distance • Combination of fluoroscopy arm and table movement should make imaging of the whole body possible • Manual override and locking should be possible

Fluoroscopy unit Table features • Support at least 140 kg of weight • Tilting capability both in craniocaudal and lateral direction • Ability to move away from C-arm in case of emergency • Additional ( foot and hand) controls to use by the radiographer

Fluoroscopy unit Imaging features • Image intensifier with large field of view (FOV) • Digital subtraction and acquisition (DSA) • Pulsed fluoroscopy for dose reduction • Variety of frame rates • Various collimators • Filters to reduce skin dose • Road mapping and land marking • Last image hold and frame grab

Fluoroscopy unit Image quality • The image quality mainly depends on the flat panel (image intensifier) and the processing system • Image quality of fixed systems >> quality of mobile systems (difference in focal spot and tissue penetration)

Fluoroscopy unit Heat capacity • Overheating is rare in modern equipment due to the presence of excellent cooling systems (oil and water based)

Fluoroscopy unit Radiation exposure • It varies greatly between different procedures • It is dependent on multiple factors. One factor is the fluoroscopy unit itself. • Radiation exposure is higher using portable Carms than fixed systems

Don’t forget

Important issues of a modern angiosuite • • • Sterility issues Ability to convert Anaesthesia Ergonomics Personnel

Important issues in a modern angiosuite Sterility issues • Angiographic and interventional procedures should be performed in strictly aseptic conditions • Primary and secondary operators should wear sterile gowns and gloves as well as surgical caps and masks. • Sterile, impervious barriers should be available to cover any part of the equipment that may contaminate the field • Appropriate receptacles for contaminated items should be readily available • OR sterility > Angiosuite sterility

Important issues in a modern angiosuite Ability to convert • Majority of endovascular procedures without major intra-operative complications • In case of conversion to open surgery, the lack of adequate lightning, suction, surgical and anaesthetic equipment and room for surgical instruments, and the extra personnel can make even small procedures challenging

Important issues in a modern angiosuite Ergonomics • Poor ergonomics is one of the major drawbacks of mobile systems • Ideally, a monitor should be placed just below eye level (10 -15 degrees angle) • Monitors on bothsides of the table • Ceiling-fixed monitors perform a great range of positions, without claiming space on the floor. Adjustment of the position of these monitors is easier

ΕΠΙΔΡΑΣΗ ΧΑΜΗΛΗΣ ΔΟΣΕΩΣ • Deterministic effects – Dose dependent – Presumed to have a threshold dose • Stochastic effects (e. g. DNA damage) – Leukemia – Thyroid cancer

Deterministic Effects • Cataracts – Observed at 2000 -8000 m. Sv (200 -800 REM) • Hair loss or skin erythema – Acute phase reaction at 2000 -4000 m. Sv – 65% of TACE cases exceed 2000 m. Sv – Many procedures where skin dose at threshold • X-ray dose is cumulative so both these effects can occur in operators as well N Hidajat. CVIR 2006; 29: 791 -796

Are The Dose Limits Low Enough? • 59 interventional radiologists screened • Signs of radiation-related lens changes (posterior subcapsular cataracts) were found in five (8 percent) • Other authors have suggested threshold for early changes may be as low as 100 m. Sv Junk A, Haskal ZJ, Machan L, Worgul B. SIR Annual Meeting. Phoenix AZ

Radiation Induced Cataract From: Vañó E, Gonzalez L, Beneytez F, Moreno F. Lens injuries induced by occupational exposure in nonoptimized interventional radiology laboratories. BJR 1998; 71: 728 -733

Dose To Lower Legs Causing Hair Loss?