Abstract
There are case reports of injuries caused by the radiation from interventional radiology (IVR) X‐ray systems. Therefore, the management of radiation doses in IVR is important. However, no detailed report has evaluated image quality for a large number of IVR X‐ray systems. As a result, it is unclear whether the image quality of the X‐ray equipment currently used in IVR procedures is optimal. We compared the entrance surface doses and image quality of multiple IVR X‐ray systems. This study was conducted in 2014 at 13 medical facilities using 18 IVR X‐ray systems. We evaluated image quality and simultaneously measured the radiation dose. Entrance surface doses for fluoroscopy (duration, 1 min) and cineradiography (duration, 10 s) are measured using a 20‐cm‐thick acrylic plate and skin dose monitor. The image quality (such as spatial resolution and low‐contrast detectability) of both fluoroscopy and cineradiography was evaluated using a QC phantom. For fluoroscopy, the average entrance surface dose using the 20‐cm‐thick acrylic plate was 13.9 (range 2.1–28.2) mGy/min. For cineradiography, the average entrance surface dose was 24.6 (range 5.1–49.3) mGy/10 s. We found positive correlations between radiation doses and image quality scores, in general, especially for fluoroscopy. The differences in surface dose among the 18 IVR X‐ray systems were high (max/min, 9.7‐fold for cineradiography; 13.4‐fold for fluoroscopy). The differences in image quality scores (spatial resolution, low‐contrast detectability, and dynamic range) were also very large. In general, there tended to be a correlation between radiation dose and image quality. Periodical measurements of the radiation dose and image quality of the X‐ray equipment used for cineradiography and fluoroscopy in IVR are necessary. The need to minimize patient exposure requires that the dose be reduced to the minimum level that will generate an image with an acceptable degree of noise.PACS number(s): 87.57.C, 87.57.uq, 87.59.B, 87.59.bf, 87.59.C, 87.59.cf, 87.59.Dj
Highlights
The X-ray conditions used for these fluoroscopy and cineradiography measurements in this study, including the dose mode, image receptor (flat-panel detector (FPD) or image intensifier, (I.I.)), field magnification mode, and recording speed, were the conditions normally used by the facilities performing percutaneous coronary intervention (PCI)
We found that the differences in radiation doses among the 18 Interventional radiology (IVR) X-ray systems were very large
The 0.012 mGy/pulse may become a criterion for the fluoroscopy pulse dose in PCI
Summary
Interventional radiology (IVR) confers a higher risk of radiation-related injury to both the patient and physician compared with other types of X-ray examination.[1,2,3,4,5,6,7,8,9,10,11,12] Even today, there are case reports of injuries (such as radiation-induced erythema) caused by the radiation from IVR X-ray systems.[13,14,15] the management of radiation doses in IVR is important.[16,17,18,19,20,21]392 Inaba et al.: Radiation dose and image quality of X-ray equipmentThe International Commission on Radiological Protection (ICRP) developed the concept of a “diagnostic reference level” (DRL).(22) DRLs are used to indicate whether, under routine conditions, patient dosage levels are unusually high or low for a given procedure.[22]. A few studies have evaluated radiation doses in several IVR X-ray systems.[23,24,25,26] To our knowledge, no detailed report has evaluated image quality (such as spatial resolution and low-contrast detectability) for a large number of IVR X-ray systems. It is unclear whether the image quality of the X-ray equipment currently used in IVR procedures is optimal
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