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The Physical Lab | Tools of the Trade
Setting Up | Catheter Placement | Baseline Measurement | SNRT | Conduction Study | Arrhythmia Induction | Pacing Protocols | Ablation | Tilt Table | Secrets to Success
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Surface ECG's | Intracardiac Questions | Med Challenge | Advanced

Tools of the Trade - XRay / Fluoro

EP with X-Ray Vision!

At the heart of every EP lab is the X-ray / Fluoro system. This workhorse of cardiology provides the physician with the ability to visualize most of the tools used during lab procedures. While systems like the EnSite NavX allows doc’s to minimize use of fluoro by allowing them to see the location of multiple catheters, it is doubtful that the use of X-Rays will be a completely eliminated in the near future.

The Fluoro Systems found in EP labs today have a number of different components.

1) There is the exam table. The table is basically a long, flat board with a thin pad on it. It is designed to hold the patient during procedures in the lab. Because the x-ray imaging equipment must be able to be positioned on either side of the patient, most tables are not very wide. They are also noted to be somewhat uncomfortable. There are controls attached to the table that allows staff to raise or lower the table as well as move it in all four directions. In some EP labs, the table is also designed to perform tilt table studies. (Please see The Patient's Page or Basic EP for more information on tilt table studies.)

2) During a procedure, the table is positioned over the x-ray source. The x-ray source is a shielded container that is attached to a C arm that extends behind and then above the table. To activate x-ray, the physician will step on a pedal. This opens the shutters allowing the x-rays to penetrate the patient. There are usually two pedals. One initiates lower dose fluoroscopy that allows the physician to "look" inside the patient.. The other triggers a higher x-ray dose for acquiring permanent images.

3) The C arm is the mechanism that allows the fluoro equipment to be positioned for different views. The C arm controls are usually on the same panel with the table controls. Ideally, the C arm will be able to be positioned behind, or to either side of the patient.

4) At the top of the C arm, above the patient is the image intensifier and camera. When the physician activates the x-ray source to acquire images, x-ray beam penetrates the patient and impacts the image intensifier, also known as the I I, (pronounced "eye-eye"). The image intensifier transfers the information it collects to a computer that converts it to a visual format, enhances the picture and then sends it to a display monitor that hangs directly in front of the physician. In older labs, the camera sits at the top of the I I where the image is directed to the film cartridge. Newer labs use complete digital systems that store the enhanced image on a hard drive and then record it to an optical disk or compact disc format.

5) The display monitors are large, high resolution screens that allow the physician to "see" inside the patient so he can position equipment appropriately. For an electrophysiology lab, it is useful to be able to position the monitors on either side of the table. This is useful during device implants that can be performed using either the right or left subclavian vein for access.

Many labs have fluoro systems with a single C arm. With the expansion of EP programs, more and more labs are switching to biplane systems. These two view systems can be especially helpful when verifying position in multiple views. While the ability to see in multiple views can reduce radiation exposure to everyone in the lab, the initial cost of these systems may make it impractical for smaller programs.

Fluoro Tables

The EP Lab would like to display images of various equipment used in EP Labs. If you have an image you would like to see in this section, please contact us by clicking on Submit Information .

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