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Variability in radiation dose and image quality: A comparison across fluoroscopy‐system vendors, generations of equipment and institutions
Author(s) -
Hill Kevin D.,
Mann Steve D.,
Carboni Michael P.,
Doyle Thomas P.,
Idriss Salim F.,
Janssen Dana F.,
Nicholson George T.,
Sathanandam Shyam,
Fleming Greg A.
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27793
Subject(s) - fluoroscopy , medicine , image quality , imaging phantom , medical physics , nuclear medicine , radiation dose , radiology , artificial intelligence , computer science , image (mathematics)
Objectives To evaluate differences in radiation dose and image quality across institutions, fluoroscope vendors and generations of fluoroscopes for pediatric cardiac catheterization. Background Increased recognition of the potentially harmful effects of ionizing radiation has spurred technological advances in fluoroscopes, as well as increased focus on optimizing fluoroscope performance. There is currently little understanding of variability in the dose–image quality relationship across institutions, fluoroscope vendor and/or generation of equipment. Methods We evaluated latest generation fluoroscopes from Phillips, Siemens, GE, and Toshiba, and an older generation Phillips fluoroscope (release date 2003) at three different institutions. Radiation dose was measured using an anthropomorphic dose‐assessment phantom with effective dose in mSv estimated from Monte Carlo simulations. Image quality phantom images were scored on a 12‐point scale by three blinded reviewers. Results Fluoroscope effective doses ranged from 0.04 to 0.14 mSv/1,000 pulses for fluoroscopy with associated composite image quality scores ranging from 8.0 ± 0.6 to 10.4 ± 1.3. For cineangiography, effective doses ranged from 0.17 to 0.57 mSv/1,000 frames with image quality scores ranging from 10.1 ± 0.3 to 11.1 ± 0.3. There was modest correlation between effective dose and image quality ( r = 0.67, P = 0.006). The older generation fluoroscope delivered consistently higher doses than the newer generation systems (2.3‐ to 3.5‐fold higher for fluoroscopy; 1.1‐ to 3.4‐fold higher for cineangiography) without appreciable differences in image quality. Conclusion Technological advances have markedly improved fluoroscope performance. Comparing latest generation systems across vendors and institutions, we found variability in the dose–IQ relationship and speculate that this reflects both equipment and institutional optimization practices.