Nationwide survey of fluoroscopy: radiation dose and image quality.

Suleiman, Orhan H.; Conway, Burton J.; Quinn, P. W.; Antonsen, R G; Rueter, F G; Slayton, R J; Spelic, David C.

doi:10.1148/radiology.203.2.9114107

Cited by 20 publications

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“…The use of diagnostic reference levels can decrease the mean dose and the width of the dose distribution of radiographic imaging procedures observed in clinical dose surveys. 6,7 Absorbed radiation dose, expressed in SI units of mGy, is a measure of the energy absorbed per unit of mass by some portion of a patient's body as a result of an exposure to ionizing radiation. For a given exposure (or radionuclide activity; see below), the absorbed dose depends on the absorbing material and the energy of the photons (or particles).…”

Section: Ct and Fluoroscopymentioning

confidence: 99%

Ionizing Radiation in Cardiac Imaging

Gerber¹,

Carr²,

Arai³

et al. 2009

Circulation

460

138

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A preliminary report on medical radiation exposures to the US population based on publicly available sources of data estimated that the collective dose received from medical uses of radiation has increased by Ͼ700% between 1980 and 2006. 1 Computed tomography (CT) has had an annual growth rate of Ͼ10% per year and accounted for Ϸ50% of the collective dose in 2006. Approximately 65% of the collective CT dose is from studies of chest, abdomen, and pelvis. In 2006, cardiac CT accounted for 1.5% of the collective CT dose; however, utilization of cardiac CT is expected to rise, with the potential to further increase exposure to the population. 1 Nuclear medicine studies in the United States have increased by 5% annually to 20 million in 2006 and accounted for Ϸ25% of the 2006 collective medical radiation dose. Among nuclear medicine studies, cardiac imaging represented 57% of the number of studies and Ϸ85% of the radiation dose. 1 A number of publications on imaging with CT, fluoroscopy, or radioisotopes have emphasized the risks that may be associated with exposure to ionizing radiation. [2][3][4] To make informed decisions concerning the use of medical radiation in imaging procedures, the following are important components: (1) A working knowledge of the principles and uncertainties of the estimation of patient dose and biological risk; (2) a comparison of the risks of radiation exposure with the risks of activities in daily life; and (3) recognition of the potential risk of failing to make important diagnoses or treatment decisions if imaging is not performed because of safety concerns.There is no federal regulation of patient radiation dose, with the exception of mammography. Most federal and state regulations are aimed at equipment performance or the handling of nuclear materials. Therefore, appropriate utilization of the equipment or nuclear material in cardiac imaging, to maintain the dose as low as reasonably achievable, is the responsibility of the imaging physician and facility. The purpose of this Science Advisory is to provide a conceptual framework and make general recommendations for the safe use of cardiac imaging that relies on ionizing radiation. Parameters of Dosimetry CT and FluoroscopyThe parameters by which ionizing radiation is quantified differ among imaging modalities. 4 The amount of radiation produced by an imaging device can be described using exposure, expressed in International System of Units (SI) units of coulombs per kilogram (C/kg), or air kerma, expressed in SI units of milligrays (mGy). This document will use the term exposure, which refers to the amount of ionization produced in air by photon irradiation. Exposure can be measured for CT and fluoroscopy with ionization chambers within test objects (phantoms) or at body surfaces with minimal difficulty. Measurable or easily derived parameters, such as entrance skin exposure in radiography and fluoroscopy and the weighted CT dose index (CTDI w ) in CT, are useful to establish diagnostic reference levels for radioThe American Heart Ass...

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Section: Ct and Fluoroscopymentioning

confidence: 99%

Ionizing Radiation in Cardiac Imaging

Gerber¹,

Carr²,

Arai³

et al. 2009

Circulation

460

138

View full text Add to dashboard Cite

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“…Consistently exceeding diagnostic reference levels suggests the need for local review and practice adaptation. The use of diagnostic reference levels for benchmarking can reduce the median dose and dose variability as assessed in periodical surveys 22, 23…”

Section: 0 Parameters To Quantify Radiation Dosementioning

confidence: 99%

Radiation Dose and Safety in Cardiac Computed Tomography

2009

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SynopsisAs a result of the changes in utilization of imaging procedures that rely on ionizing radiation, the collective dose has increased by over 700% and the annual per-capita dose, by almost 600% over recent years. It is certainly possible that this growing use may have significant effects on public health. Although there are uncertainties related to the accuracy of calculated radiation exposure and the estimated biologic risk, there are measures that can be taken to reduce any potential risks while maintaining diagnostic accuracy. This article will review the existing data regarding biological hazards of radiation exposure associated to medical diagnostic testing, the methodology used to estimate radiation exposure and the measures that can be taken to effectively reduce it. IntroductionIn recent years, reports on radiation exposure resulting from medical imaging have unfailingly attracted intense attention by the media, whose reporting typically emphasizes the risks of such exposure. It is certainly possible that the growing use of imaging procedures that rely on ionizing radiation may have significant effects on public health. However, the potential health risks of ionizing radiation at the levels used in medical imaging are rarely portrayed in a balanced fashion that would highlight the patterns of use of medical imaging, the uncertainties about the magnitude of risk of cancer, or the undeniable benefits of medical imaging in specific scenarios. The purpose of this review is to provide an understanding of 1. the strengths and shortcomings of epidemiologic evaluations of radiation exposure to the general population, 2. the uncertainties related to radiation dosimetry and estimating the biologic risk (including carcinogenesis) resulting from exposure to ionizing radiation, and 3. the measures that can be taken to maximize our opportunities to perform the right study in the right patient with a radiation dose that is as low as reasonably achievable. In keeping with the main theme of the current issue of Cardiology Clinics, our review will focus on cardiac CT imaging in adults.Address for Correspondence: Thomas C Gerber, M.D., Ph.D., Associate Professor of Medicine and Radiology, Division of Cardiovascular Diseases, Mayo Clinic, 4500 San Pablo Road, Jacksonville, Florida 32224, gerber.thomas@mayo.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Taken together, the estimated 67 million CT (computed tomography) and 19 million nuclear medicine studies performed in 2006 accounted for 22% of imaging procedures that used ionizing radiation but 75% of the collective E (ex...

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“…Fluoroscopic contrast resolution can also be assessed by using several different test objects, including the Fluoro-Test tool (9), Leeds test object TO.N3 (10), and the image quality test object of the Center for Devices and Radiological Health (CDRH) of the Food and Drug Administration (11). Each of these test objects contains a series of steps of varying contrast.…”

Section: Discussionmentioning

confidence: 99%

Quantification of Fluoroscopic Imaging System Contrast by Using Video Waveform Monitoring

Taubel¹,

Schueler²,

Vrieze³

et al. 2001

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A noninvasive method was developed for quantifying the overall contrast of fluoroscopic imaging systems within the clinical setting by using a simple phantom and common video test equipment. In this method, an acrylic phantom with four holes filled with varying amounts of air and aluminum is placed on the entrance exposure side of a patient-equivalent acrylic phantom. The air-and aluminum-filled holes provide a stepped gray-scale pattern that is displayed on the examination room viewing monitor when the phantom is fluoroscopically imaged under automatic brightness control. A video waveform monitor or oscilloscope is then used to quantify those video signal voltage levels as a contrast index value, which is defined as the maximum range of the video signal voltage levels of the gray-scale steps. The method is repeatable and allows quantification of the contrast of the imaging system. It can also be used to optimize video parameters, provide comparative data for quality control monitoring, and characterize overall contrast differences between systems. Experience with this method suggests that there is excellent correlation between the clinical perception of image contrast and the contrast index, with contrast index changes of approximately 15% being seen clinically.

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Nationwide survey of fluoroscopy: radiation dose and image quality.

Abstract: Spatial resolution for fluoroscopy is adequate for most of the facilities surveyed, but a substantial proportion of facilities could not visualize low-contrast test objects, which strongly suggests image quality problems.

Cited by 20 publications

References 0 publications

Ionizing Radiation in Cardiac Imaging

Ionizing Radiation in Cardiac Imaging

Radiation Dose and Safety in Cardiac Computed Tomography

Quantification of Fluoroscopic Imaging System Contrast by Using Video Waveform Monitoring

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