Abstract
The aim of this study was to assess image quality and radiation dose of a biplane angiographic system with cone‐beam CT (CBCT) capability tuned for pediatric cardiac procedures. The results of this study can be used to explore dose reduction techniques. For pulsed fluoroscopy and cine modes, polymethyl methacrylate phantoms of various thicknesses and a Leeds TOR 18‐FG test object were employed. Various fields of view (FOV) were selected. For CBCT, the study employed head and body dose phantoms, Catphan 504, and an anthropomorphic cardiology phantom. The study also compared two 3D rotational angiography protocols. The entrance surface air kerma per frame increases by a factor of 3–12 when comparing cine and fluoroscopy frames. The biggest difference in the signal‐to‐noise ratio between fluoroscopy and cine modes occurs at FOV 32 cm because fluoroscopy is acquired at a 1440×1440 pixel matrix size and in unbinned mode, whereas cine is acquired at 720×720 pixels and in binned mode. The high‐contrast spatial resolution of cine is better than that of fluoroscopy, except for FOV 32 cm, because fluoroscopy mode with 32 cm FOV is unbinned. Acquiring CBCT series with a 16 cm head phantom using the standard dose protocol results in a threefold dose increase compared with the low‐dose protocol. Although the amount of noise present in the images acquired with the low‐dose protocol is much higher than that obtained with the standard mode, the images present better spatial resolution. A 1 mm diameter rod with 250 Hounsfield units can be distinguished in reconstructed images with an 8 mm slice width. Pediatric‐specific protocols provide lower doses while maintaining sufficient image quality. The system offers a novel 3D imaging mode. The acquisition of CBCT images results in increased doses administered to the patients, but also provides further diagnostic information contained in the volumetric images. The assessed CBCT protocols provide images that are noisy, but with very good spatial resolution.PACS number(s): 87.59.‐e, 87.59.‐C, 87.59.‐cf, 87.59.Dj, 87.57. uq
Highlights
The International Commission on Radiological Protection and the European Commission[1,2,3] require interventional X-ray systems to undergo a series of tests prior to use to ensure that the equipment performs satisfactorily in clinical practice
These tests cover two main aspects: 1) the entrance surface air kerma (ESAK) of an appropriate phantom under normal operating conditions, simulating various patient thicknesses in the commonly used imaging modes: fluoroscopy, cine and, more recently, the three-dimensional rotational angiography (3D-RA), known as cone-beam CT (CBCT); and 2) image quality assessment for the various imaging protocols used in clinical practice
The results can be used to explore optimization strategies to reduce the dose to a level such that the dose does not compromise the image quality required for the best clinical outcome
Summary
The International Commission on Radiological Protection and the European Commission[1,2,3] require interventional X-ray systems to undergo a series of tests prior to use to ensure that the equipment performs satisfactorily in clinical practice These tests cover two main aspects: 1) the entrance surface air kerma (ESAK) of an appropriate phantom under normal operating conditions, simulating various patient thicknesses in the commonly used imaging modes: fluoroscopy, cine and, more recently, the three-dimensional rotational angiography (3D-RA), known as cone-beam CT (CBCT); and 2) image quality assessment (using test objects) for the various imaging protocols used in clinical practice. The results can be used to explore optimization strategies to reduce the dose to a level such that the dose does not compromise the image quality required for the best clinical outcome
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