Physics 5

Fluoroscopy
• Definition
– Use of x-rays to produce a dynamic sequence of images ,which are viewed in
real time
Types:
-Direct viewing fluoroscopy
-Image intensifier
-Flat panel systems
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1) Direct viewing fluoroscopy
• Oldest fluoroscopy
• Radiology directly viewed using zinc sulphide fluorescent
screen
• screen backed with lead glass for protection
• Limitation: dim image
– Must be carried in dark room, with very low contrast images (rods
=scotopic vision)
Fluorescent
screen
2)Image intensifier

The Image Intensifier
Photocathode Focusing electrodes
e-
e- Anode
e-
e-
e-
X-rays e-
electrons
e-
e- e-
e- Output
e- Phosphor
e-
Input Phosphor

e-
e- Anode
e-
e-
e-
X-rays e-
electrons
e-
e- e-
e- Output
e- Phosphor
e-
• The incident x-rays are converted to visible light

when they hit the phosphor

e-
e- Anode
e-
e-
e-
X-rays e-
electrons
e-
e- e-
e- Output
e- Phosphor
e-
• Visible light is converted to electrons by the photocathode.
• Electrons are accelerated towards the output phosphor.

e-
e- Anode
e-
e-
e-
X-rays e-
electrons
e-
e- e-
e- Output
e- Phosphor
e-
• Electrons are converted back to visible light by the output

phosphor.

• Components of image intensifier:
1- Glass or ceramic envelope surrounded by
metal housing:
Function :
A) Prevent light from getting in the tube
B) Shield the device from magnetic field

2- Input screen :
• Consists of:
A) Input phosphor layer:
-Laid down in a thin metal layer
-At the outer (X-ray beam) side of
the input screen
-Always: cesium iodide
-Advantages: absorption
 High absorption efficiency
(About 60% of the X-ray energy
photons in 0.1-0.4 thick
phosphor layer) X-ray
Because k-edge of cesium = 36 kev

, and I = 33 kev (just below the
used effective energy) light
 Low unsharpness with thicker
phosphors (why?) *
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Input screen (cont.)
• Size: 150 – 400 mm in diameter
• Smallest for fracture fixation
• Largest for angio

3) photocathode:
•Thin coating material on the inner side of the input screen

•It emit electrons when irradiated by light
•Number of electrons emitted α with intensity of light α
with intensity of X-ray
•Commonly : antimony caesium
•It is maintained with high –ve voltage with respect to
anode e.g 25kv
4- electron focusing electrodes:
• Metal rings within the tube
• Has + ve voltage with respect to
photocathode Focusing
• Constrain electrons to travel electrodes
directly to output screen so
that: pattern of electron -
intensities falling on the screen -
are identical as (but minified)
pattern of intensities produced
in the input screen
• i.e. functions as electron lens
• If absent : electrons reach the
output screen in disorganized
pattern → no image formed
I.I. Input Screen
Electrode E1
Electrode E2
Electrode E3
I.I.Output Screen
Photocathode
+
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5- output screen:
• 25-35 mm in diameter (10 times smaller than input
screen)

• Consists of:
A) Thin phosphor layer (zinc cadmium sulphide ZnCdS):
– Converts pattern of electron intensities into light
– It must be so thin (few μms) to decrease light spread in the screen
– It Emits green light
– Brightness displayed in the output screen is α intensity of X-ray (X-ray
doubled → screen Brightness doubled) i.e. γ=1
B) Extremely thin layer of aluminum (0.5) covering the output screen
– Function:
1) Prevent light emitted backwards towards the tube from reaching
photocathode causing cascade of electron emission that would
completely whiteout the image
2) Acts as anode with +ve voltage with respect to cathode e.g 25kv →
acceleration of electrons towards the output screen
Output
Phosphor
Aluminum

Summary of image intensifier

Fluoroscopy image characteristics
Brightness Gain:
• Definition: Ratio of brightness of the output
phosphor to that of the input phosphor =
degree of intensification

• Brightness gain is Caused by two factors:
1) Flux gain :
Single light photon from the input phosphor → single electron from the
photocathode → accelerated at 25Kev → many (about 50) light photons
from output phosphor
2) Minification gain:
Intensification caused by decrease of the image size from input to output
screen
Equal to ratio of the area of both screens = 300²/30² = 100
Overall brightness gain = Flux gain x Minification gain = 50 x 100 = about 5000

Conversion factor = Gx:
brightness (luminance) at output phosphor (candela.m¯²)
= -------------------------------------------------------------
dose rate at the input surface of image intensifier (μGy .s¯¹)
• Used to describe the performance of image
intensifier (as the gain is not measurable)
• Typical value = 25-30 candela.m¯² (μGy .s¯¹) ¯¹
• Gain and Gx decrease with equipment usage
due to loss of detection efficiency of
phosphors

• Magnification:
• Image in the output
phosphor is a minified
version of the image
• To magnify the image:
– Voltage of the
intermediate electrodes is
changed → electron
focus moves backwards
→ central part of the
image only fill the output
phosphor
• Advantages: better
resolution
•Disadvantages: ↓minification input phosphor
gain→↓image brightness zoom 0
•To restore brightness zoom 1
→↑exposure factors with : zoom 2
↑ enterence skin dose

•All the image intensifiers offer at output phosphor
least one magnified fields of view

Closed Circuit TV Systems
• Used to display the image of the output phosphor
• Consists of :
– TV Camera
– Camera control unit
– Monitor
• Image intensifiers and television camera tubes are manufactured so that
the output phosphor of the image-intensifier tube is the same diameter as
the window of the television camera tube, usually 2.5 or 5 cm

Image Intensifier – TV camera Coupling
• 1) Lens coupling
• 2) Fiber Optic
coupling

Lens Coupling XRII output
phosphor
aperture
• Allows splitting of light from

intensifier using semitransparent TV camera
mirror (beam splitter) tandem lens system
faceplate
Photodiode array
• 90% of light to goes to the film
and 10% of light to the TV camera
TV
• aperture used to control amount of Beam

light falling on camera faceplate (and Photocam Splitter
to control the degree of vignetting) or Mirror
cine
Output
Phos phor
Im age
Intens ifier
Tube
Dr.Yossef Gamal Www.ScoreTraining.net Input

Phos phor
Fiber Optic Coupling
• Advantages:
– More effective in light collection
– Less geometrical distortion
• Disadvantage:
– cannot record image directly from image tube (All
recording done from TV)
TV
Fiber Optic Bundle
Image
Intensifier
Tube
Types of TV cameras used
 VIDICON TV camera
 improvement of contrast
 improvement of signal to noise ratio
 high image lag
 PLUMBICON TV camera
 lower image lag (follow up of organ motions)
 higher quantum noise level
 suitable for cardiology

How does TV camera operate
• The camera tube is a vacuum tube , that has a photoconductor (anode) in which the
light from intensifier output screen is incident.
• In a PLUMBICON tube, this layer is made of lead oxide, whereas in a VIDICON,
antimony trisulphide is used
• Electron beam is produced by heating a photocathode , and is focused to the
photoconductor by focusing coils so that the electron beam moves across the
surface of the TV camera tube in a series of lines
• The surface of the photoconductor scanned with the electron beam results in a
flowing current inside the signal plate
• The amount of current is related to the amount of light incident on the conductor.
• The current (video signal) is then transferred to the CRT monitor for display

CRT Monitor
• The scanning electron beams of the TV camera and the CRT
monitor move in synchronism.
• The current of the scanning beam in the TV monitor, is
related to that in the TV camera.
• Consequently, the brightness of the image on the TV
monitor is proportional to the amount of light falling on the
corresponding position on the TV camera.

Some points regarding the CRT monitor
• 1) TV Interlacing: frame scanned in two
passes, first the odd lines then the even
– Advantage: avoids flicker
– each pass takes 1/60th second → One
frame takes 1/30th second
1st Field (Odd lines) + 2nd Field (Even lines) = One Frame
+ =
Dr.Yossef Gamal 1/60th sec. 1/60th sec.

Www.ScoreTraining.net 1/30th sec.
• 2) progressive scanning
– used on newer systems, lines scanned in order
– no interlacing

•CRT Vertical Resolution: proportional to # of scan
lines
•CRT Horizontal Resolution: Depends on
modulated signal frequency = cycles/scan line

Digital fluoroscopy
•Advantages
1- computer image storage
2-image processing (e.g edge enhancement ,
geometrical inversion , mapping to look-up tables to
↑contrast)
This processing can be done in real time

Digital fluoroscopy
1) with use of ordinary video camera:
• Signal from video camera → ADC → digital
format → displayed on the computer

2) With use of CCD camera
- Linked to the intensifier output
phosphor by fiber-optic coupling
- CCD camera is formed of Input
screen ( amorphous silicon) divided
into pixels (1024 x 1024)
- Each pixel acts as a small capacitor
- Charge collected α intensity of light
falling on the pixel
- Read-out of pixel charges is so rapid
(allow image sequence of 30
frames/s or faster)
- Advantages :
- produce signal in digital format
- High dynamic range (12-bit image
depth)

Automatic brightness control (ABC)
• In fluoroscopy manual Kv and mA control is
not practical (region of the patient imaged
changes rapidly)
• Aim of ABC: automatic adjustment of Kv & mA
to keep the output screen light intensity to the
required level

Input signal of ABC may be:
1-light intensity of the output screen of the image intensifier with optic coupling using
a photodiode (older systems)
Area of output screen used is the central area (area of clinical interest), some systems
allow operators to choose it manually
Automatic
Brightness
Control Sensor
Light
Intensity
Generator
Exposure
Control
KVp
mA
2- signal from camera (more in modern systems):
Signal change feedback to the generator
→automatic adjustment of Kv & mA

Anti-isowatt curves:
• ABC is controlled by different types of programmed curves
Curve A: increase in radiological thickness→↑Kv & ↑mA
(maximum power limit = 400 W = 400 J/s)

Curve B = image quality weighted curve:
Tube potential is kept between 60-70 Kv , which is optimum for Iodine imaging (k-edge
= 33 kev)
So that when the radiological thickness increase →↑mA
At power of 400 W (power rating) tube cant sustain → if more thickness → ↑Kv & ↓
mA (so that power rating is not exceeded
Advantages : good image contrast
Disadvantages : ↓kv →↑dose
Uses: contrast studies , angiography

Curve C: dose weighted curve:
Increase of radiological thickness →↑Kv rapidly up to maximum Kv that can be
sustained by the tube (kv rating)
If more thickness → maximum Kv is used with increasing mA (= high kv curve)
Advantages: ↑Kv → low patient dose
Disadvantage: less image quality
Uses: pediatrics

Automatic gain control
• Alternative to ABC , but adjust brightness by adjusting the
gain of TV system
• Disadvantage : either will↑ image noise or will cause
unnecessary dose
• Example:
– fluoroscopy is used at certain Kv and mA
– When thickness decrease →kv and mA are stable and AGC is in
charge → image brightness is adjusted but the kv and mA are
high for the thickness imaged →
1-unnecessary dose
2-less noisy image
Think what will happen if the thickness increase?

Fluoroscopy dose rates
Fluoroscopy dose rate depends on:
1- DQE of image intensifier (detection efficiency
is high for CsI = 60%)
2- level of noise that can be accepted:
– Input dose rate of image intensifier is usually
adjusted to the range of 0.1-0.5 µGy/s (about
0.25)
– The lower the input dose , the greater is the noise
– ABC will give lowest brightness possible at which
compensation by TV gain will cause accepted
noise
3- Magnification (field size) :
magnification →↓ of the minification gain →dose is ↑ to keep the same
brightness → ↑ ESD
But the area scanned is also decreased→ dose area product is
unchanged (theoretically)
Yet in practice:
compensation is not only done by ↑ dose , but also by ↑ TV gain
So that dose area product is reduced to some extent during
magnification

4- pulsed fluoroscopy: two types:
 A) primary control pulsed fluoroscopy:
o X-ray generator switching on and off on regular intervals
 B) Grid controlled tube (direct control):
o Circular tube electrode between filament and target with –ve
voltage (2kv) is switched on and off → electrons pass and then
repel and then pass … etc.
o Advantages: more precise switching with good control of X-ray

• At rate of 25-30 pulses/s → the
eye is not able to detect pulses
• Most of continuous fluoroscopy
are actually pulsed
• Each image is retained on the
monitor until the following is
displayed
• at low pulse rate: 100
90
1- no flickering 80
Relative dose rate %

70
2- image lag 60
50
3- dose rate falls (but not exactly in 40

30
proportion to the decrease in 20 measured
expected
10
pulse rate – equipment design 0
dependant)
25 20 15 10 5
fluoro pulse rate (pulse/s)
0
Fluoroscopy and ESD
• Entrance surface dose (ESD): can never exceed
100 mGy/min (or 50 mGy/min) for any field of
view in fluoroscopy
• In practice with modern equipment : it is in
the range of 10-30 mGy/min

Fluoroscopy recorded images
• Fluoroscopy is usually used for positioning
(e.g. biopsy) , it is rarely diagnostic (real-
time , and poor image quality)
• For diagnosis, images must be recorded
and stored by some way in high quality
during fluoroscopy operation
1- non digital fluoroscopy
A) spot films with film screen:
• Cassette holder (with film screen inside) is
parked outside the radiation beam
• On pressing the switch to record the image
→ cassette is driven between the grid and
the image intensifier and exposure is made
(with delay of about 1 s.)
• Multiple successive exposures can be
made in single film using collimator (e.g.
barium swallow)
B) spot films with fluorography
• Definition: recording images produced by image intensifier output screen
• Mirror is introduced between output screen of the image intensifier and the
TV camera to take spot films using static camera
• Film size = 105 mm [30% of films produced in method (A)]
• X-ray tube operated in radiographic mode (about 300 mA)
i.e. High mA (with short exposure time) →decrease noise
N.B: Cine camera may be used instead of static camera (e.g. cardiac studies)
Using pulsed X-ray exposure (pulse rate = camera frame rate)

2- spot images in digital fluoroscopy
• Always done using fluorography
A- Last image hold = fluorograb:
• Computer stores the last frame of fluoroscopy (continue to appear in the
monitor after switching off the X-ray)
• Advantages: operator can inspect the image without additional radiation
• Disadvantages: low quality image
B- digital spot images:

• Single shot image taken with ↑mA to decrease the noise
• Required image intensifier dose to provide adequate image quality = 0.5
– 5 µGy (exact value depends on magnification degree and clinical
requirement)
• If 0.5 µGy is required to produce the spot image → equal to dose
produced by 2 seconds of fluoroscopy screening (remember Image
intensifier dose rate)
• N.B: Sequential images can be recorded (total number is dependant on
computer memory e.g. angiography

Spatial resolution of fluoroscopy:
1- in image intensifier itself:
• Resolution is limited by spread of light in the output
phosphor
• At this step : resolution = 4-5 lp/mm (somewhat better for
magnified views)
• Spatial resolution α image size at the input face of image
intensifier
i.e. : Resolution is defined in terms of the image size at the
input face of image intensifier
3.0
limiting resolution (lp/mm)
2.5
2.0
1.5
1.0
0.5
0.0
10 20 30 40
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2- resolution seen in the monitor
display:
More limited than step 1
a) Using CCD :
CCD consists of 1024 x 1024 pixels
So that : for 350 mm FOV → pixel size =
290 µm → spatial resolution = 1.7
lp/mm
Yet , actually , it is not more than 1.2
lp/mm)
Improved to 3 lp/m for magnified view
b) Using Older vacuum tube camera:
Similar resolution as CCD
What are the factors affecting resolution
here?
Noise in fluoroscopy
• Significant feature of fluoroscopy (why?)
• Quantum sink corresponds to the photons absorbed in the input screen
i.e. nothing will ↑S/N ratio after this step ( e.g. camera gain)
• To decrease the noise:
1) Increase input dose rate by ↑ mA
2) frame averaging: adding signals from successive frames
– Advantages:
a- ↓ noise (equivalent to increasing exposure time) with higher ability to see low
contrast details
B- smoothing the image
– Disadvantages: blurring if high level of motion between frames
– ↑number of frames added →↓image noise →↑blurring

Frame 1 Frame 1+2 Frame 1+2+3 Frame 1+2+3+4
Veiling glare
• Causes: scattering effect in the image intensifier:
1- light scattering in the output window (mainly)
2- X-ray and light scatter in the input phosphor
3- electron scattering in the tube itself
• The larger is the image intensifier , the greater is the Veiling glare
• Effect:
1- decrease the contrast because dark regions of the image appear
lighter
2-makes the central area of the image appear brighter than the
periphery = vignetting
N.B: other causes of
vignetting :
Image brightness
A) periphery of the image is
displayed over larger area of
the input screen
B) poor periphery focusing
Position across image

Geometrical distortion
• Types:
1- pin cushion distortion:
Magnification towards the edges
of the image
Due to curvature of the input
screen
2- S- type distortion:
Impose curvature on the straight
line features
Due to ambient magnetic fields
influencing path of electrons
from input to output screens
Both are insignificant when
imaging complex shapes within
the body
Testing the spatial resolution
• Using grid test
• Test is carried out without any
attenuating materials in the beam
• ↓ kv is used to minimize the scatter
• Detect any deterioration in the
image intensifier focusing

Testing the contrast resolution
• under standard fluoroscopy conditions (70 kv , 1-2 mm copper filter)
• Using low contrast test object (e.g. Leeds test object) which is a flat disc , 6mm in
thickness , 200-300 mm in diameter
• Contain groups of circular inserts of ↑ Z,
• Example: 12 groups of circular details
• Each group has diameter A , and Each group is composed of 9 disks
• Thickness of the disks of each group increase progressively to produce varying
levels of contrast
• Observer is required to count the number of details that can be seen in each
group
• Usually it is not possible to see more than 6 details in any group , and more than
1 detail in the smallest diameter group
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from Al, Cu or Ag discs x-ray image
½
• Ht (A) = [ Ct (A) x A ]¯¹
• Ht (A) : threshold detection index of group A
• Ct (A) : threshold contrast of group A
(minimum visible contrast)
• A: diameter of the group
• Ht (A) is plotted against A to detect imaging
performance (by comparing it to the previous
tests)

3) Flat Panel Detectors
• Flat panel detectors are
becoming more and more used in
fluoroscopy.
• Flat panel detectors will replace

the image intensifier-TV based
fluoroscopy systems
• Indirect conversion (with an

intermediate step) most common
The use of flat panel detectors instead of image
intensifier in fluoroscopy
Flat panel detectors Image intensifier with CCD
camera
DQE 60-65 % 60-65% (both use CsI)
Dynamic range and Very high (14 bit depth) → CCD has good contrast
contrast better contrast resolution (12 bit depth) , yet ,
contrast is limited due to
veiling glare → contrast ratio
is not better than 30:1
Pixel size 150 µm (resolution = 3lp/mm) 400 µm (resolution = 1-1.2
lp/mm)
magnification Does not affect spatial Resolution improve with
resolution (pixel size is the magnification (for the smallest
same) field of view resolution of
both systems are comparable
Geometrical distortion -ve +ve
CT scanner Can be used in multislice CT Can be used but limited due
scanners to circular FOV and
Dr.Yossef Gamal Www.ScoreTraining.net geometrical distortion
Types of fluoroscopy tables
1) TUBE ABOVE THE TABLE = Over couch Tubes

2) TUBE UNDER THE TABLE = under couch X-ray tube

3) C-ARM FLUOROSCOPY:
Tube and intensifier move together around the patient

Digital subtraction angiography

• Objectives:
1) produce image of contrast filled vessels in
isolation from other tissues
This will increase vessels clarity and decrease dose
of contrast
2) rapid image succession to avoid patient
movement

• Process:
A) two non contrast images are taken (first : to stabilize x-ray factors , second: used as mask
image (image A)
B) post-contrast image is taken (image B)
C) A is subtracted from B on a pixel to pixel basis → result in subtraction image C or D
(shows the filled vessels only)
D) sequence of subtracted images can be recoded , based on the initial mask (and may be
viewed in real time)
E) signals in the contrast and mask images are first converted to their logarithms before
subtraction , and then are converted back into intensity values for display

Problem(1): motion misregistration:
• Cause: movement between frames
• Particularly at boundaries between high contrast objects (e.g.
at bone edges)
• Solution: pixel shifting:
– retrospective adjustment of the mask image
– This can be done only over the full area of the image (no differential
movement within the field of view)
– Can be done manually or using automated techniques

Problem (2): increased noise
• Cause : subtraction cause that the number of
pixels contributing to each pixel is decreased
• Solution: DSA requires increased mA
2 µGy per frame 15 µGy per frame 24 µGy per frame

Problem (3): length of anatomy imaged is
usually greater than image intensifier field of
view (e.g. lower limb angio)
• Solution (1):
-several mask images are acquired
-separate contrast administration for each region
• Solution (2):
– Several mask images are acquired
– Single contrast image is acquired along the full
leg length with longitudinal movement of the
table to track the progress of contrast
– Appropriate mask image for each table position is
used in the subtraction
– Advantage: ↓amount of contrast medium used
– Disadvantages: increase likelihood of movement
between mask and contrast images
Rotational angiography
• 90⁰ rotation x-ray tube and intensifier about the
patient → mask images are taken at several angles
• Post-contrast images are acquired at the same angles
• DSA are produced at each angle
• Advantages:
1-identification of optimum angle to view the vessel
2- three dimensional reconstruction

Dual energy subtraction

Dual energy subtraction
1)image A is taken at
low Kv → high
contrast between
bone and soft tissue
2) image B is taken at
high Kv → contrast is
reduced 1000
3)Subtraction process:
linear attenuation coeff (cm-1)

100
– B – A → minimize soft tissue
visualization of bone
bones and improves 10
soft tissue contrast
(e.g. chest x-ray to 1 A
remove rib
densities)
– A – B → displays 0.1 B
bony structures in
greater details 0.01
0 20 40 60 80 100
Dr.Yossef Gamal Www.ScoreTraining.net energy (keV)
Imaging Screen MTF
• improves with magnification
• Why?
– magnification of an object of
given frequency reduces
frequency seen by screen


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Fluoroscopy

Dr.Yossef Gamal Www.ScoreTraining.net

Dr.Yossef Gamal Www.ScoreTraining.net

Dr.Yossef Gamal Www.ScoreTraining.net

• The incident x-rays are converted to visible light

Dr.Yossef Gamal Www.ScoreTraining.net

• Visible light is converted to electrons by the photocathode.

• Electrons are accelerated towards the output phosphor.

Dr.Yossef Gamal Www.ScoreTraining.net

• Electrons are converted back to visible light by the output

Dr.Yossef Gamal Www.ScoreTraining.net

Dr.Yossef Gamal Www.ScoreTraining.net

Because k-edge of cesium = 36 kev

Dr.Yossef Gamal Www.ScoreTraining.net

•Thin coating material on the inner side of the input screen

Www.ScoreTraining.net Dr.Yossef Gamal

Dr.Yossef Gamal Www.ScoreTraining.net

Dr.Yossef Gamal Www.ScoreTraining.net

Dr.Yossef Gamal Www.ScoreTraining.net

Dr.Yossef Gamal Www.ScoreTraining.net

Dr.Yossef Gamal Www.ScoreTraining.net

Dr.Yossef Gamal Www.ScoreTraining.net

•To restore brightness zoom 1

→↑exposure factors with : zoom 2

↑ enterence skin dose

least one magnified fields of view

Dr.Yossef Gamal Www.ScoreTraining.net

Dr.Yossef Gamal Www.ScoreTraining.net

Dr.Yossef Gamal Www.ScoreTraining.net

• Allows splitting of light from

• aperture used to control amount of Beam

Dr.Yossef Gamal Www.ScoreTraining.net Input

Fiber Optic Bundle

Www.ScoreTraining.net Dr.Yossef Gamal

Www.ScoreTraining.net Dr.Yossef Gamal

Dr.Yossef Gamal Www.ScoreTraining.net

Dr.Yossef Gamal 1/60th sec. 1/60th sec.

Dr.Yossef Gamal Www.ScoreTraining.net

Dr.Yossef Gamal Www.ScoreTraining.net

Dr.Yossef Gamal Www.ScoreTraining.net

Dr.Yossef Gamal Www.ScoreTraining.net

Dr.Yossef Gamal Www.ScoreTraining.net

Dr.Yossef Gamal Www.ScoreTraining.net

Dr.Yossef Gamal Www.ScoreTraining.net

Dr.Yossef Gamal Www.ScoreTraining.net

Dr.Yossef Gamal Www.ScoreTraining.net

Dr.Yossef Gamal Www.ScoreTraining.net

Think what will happen if the thickness increase?

Dr.Yossef Gamal Www.ScoreTraining.net

Dr.Yossef Gamal Www.ScoreTraining.net

Dr.Yossef Gamal Www.ScoreTraining.net

Relative dose rate %

3- dose rate falls (but not exactly in 40

Dr.Yossef Gamal Www.ScoreTraining.net

Dr.Yossef Gamal Www.ScoreTraining.net

B- digital spot images:

Dr.Yossef Gamal Www.ScoreTraining.net

Dr.Yossef Gamal Www.ScoreTraining.net

Position across image

Dr.Yossef Gamal Www.ScoreTraining.net

Dr.Yossef Gamal Test object made

Dr.Yossef Gamal Www.ScoreTraining.net