Medical imaging using ionizing radiation: Optimization of dose and image quality in fluoroscopy

Abstract

The 2012 Summer School of the American Association of Physicists in Medicine (AAPM) focused on optimization of the use of ionizing radiation in medical imaging. Day 2 of the Summer School was devoted to fluoroscopy and interventional radiology and featured seven lectures. These lectures have been distilled into a single review paper covering equipment specification and siting, equipment acceptance testing and quality control, fluoroscope configuration, radiation effects, dose estimation and measurement, and principles of flat panel computed tomography. This review focuses on modern fluoroscopic equipment and is comprised in large part of information not found in textbooks on the subject. While this review does discuss technical aspects of modern fluoroscopic equipment, it focuses mainly on the clinical use and support of such equipment, from initial installation through estimation of patient dose and management of radiation effects. This review will be of interest to those learning about fluoroscopy, to those wishing to update their knowledge of modern fluoroscopic equipment, to those wishing to deepen their knowledge of particular topics, such as flat panel computed tomography, and to those who support fluoroscopic equipment in the clinic.

IPEM Topical Report: an evidence and risk assessment based analysis of the efficacy of tube and generator quality assurance tests on general x-ray units

“…Sub-division by program name was considered, however there was too great a variability in program name with manufacturer and model to be confident that the comparison was appropriate. [12] indicate that for an II of 30 cm nominal diameter at 30 frames per second, the DIDR should be 260 nGy s -1 and suggest corrections for pulse rate and field size for both II and FPD. They also note that for FPD there is a restriction on the lowest dose rate of 20 to 50nGy per pulse due to levels of electronic noise (this may vary with different generations of digital detector) and that the dose floor can be lower in the case of II due to lower amounts of electronic noise present.…”

Imaging Techniques to Aid IR Treatment of Musculoskeletal Malignancy

“…Ultrasound probes are available in a variety of configurations including linear, curvilinear, sector, and two-dimensional (2D) matrix transducers. Linear arrays are typically higher frequency (e.g., [5][6][7][8][9][10][11][12], which limits depth of penetration but provides superior resolution for superficial structures. Curvilinear arrays are typically lower frequency (e.g., 1-5 MHz), offering increased depth of penetration and a larger field of view (FOV), but lower resolution.…”

“…Several adjunct imaging modes are available on fluoroscopic systems, including digital acquisition imaging, digital subtraction angiography (DSA), roadmapping, and fluoroscopy reference overlay. 12 Digital acquisition imaging uses high-dose rates to produce a series of radiographic-quality images for diagnosis, while DSA typically uses even higher dose rates to produce background-subtracted images of only contrast-filled vasculature. DSA images are ideally free of anatomical background, and remasking or pixel shifting techniques can be used to correct for motion artifact.…”

Toward Personalized Imaging in Image-guided Radiotherapy

“…When possible, replacing 3-dimentional CBCT scans with 2-dimentional imaging is a good choice. Restricted use of fluoroscopy is also recommended [26]. The choice of image modality and parameters should be evaluated carefully based on the clinical goal for the specific patient.…”