More than six years have passed since Dr. W. Edward Chamberlain delivered the annual Carman Lecture before the Radiological Society of North America. In this lecture (1), he described in great detail the limitations of present-day fluoroscopy, and held out hope that these severe restrictions might soon be removed, or greatly alleviated, by the application of modern electronic technics to the amplification, or brightening, of fluoroscopic images. Such amplification has recently been accomplished in the Research Laboratories of the Westinghouse Electric Corporation, and it is hoped that before long practical realization of the method for use in clinical fluoroscopy will become available to the radiologist. There are two reasons why image amplification, or brightening, is necessary if large increases of brightness are to be obtained. First, x-ray intensities are already at the patient's tolerance level and may not be further increased without danger of injury. Second, there is not sufficient energy in the emerging x-rays to form an adequately bright picture even if all the energy were converted into light. Image amplification has been achieved by converting the x-ray pattern into an electron stream, and accelerating these electrons to high velocities. In this way, energy from an external source is introduced into the system and, when the electrons impinge on a phosphor layer, a brighter image results. This paper deals with the technical aspects of fluoroscopic image amplification, and describes in some detail the mechanism just outlined. Were it not for the dimness of the image, fluoroscopy would replace to a large extent the taking of roentgenograms. A single fluoroscopic examination would be equivalent to hundreds of films taken in cinematographic sequence and revealing the subject in all phases of movement and from many angles of projection. Unfortunately, however, the fluoroscopic image is excessively dim, and at existing brightness levels the human eye is capable of perceiving only a fraction of the detail which is actually on the screen. Dr. Chamberlain covered this aspect of the problem very thoroughly, and it will suffice to present here only a few aspects of retinal physiology which will serve to illustrate the tremendous ranges of brightness over which the eye is adaptable, and the great loss of definition which is incurred at low levels. The brightness level at which roentgenograms are ordinarily viewed is roughly 30 millilamberts. At this level, the eye is capable of recognizing as discrete two contours which are separated by as little as one one-thousandth of an inch. As the brightness of the object is decreased, the visual acuity of the eye deteriorates. At about one thousandth of this intensity we have reached the point where cone vision is no longer effective, the color sense is gone, and the fovea centralis is no longer the most sensitive part of the retina.
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