Evaluation of patient entrance dose rate of interventional X-ray equipment

Abstract

Because interventional radiology (IVR) procedures are being performed with increasing frequency, patient X-ray exposure dose for X-ray fluoroscopic and radiographic procedures should not be ignored. In order to avoid excessive X-ray exposure, exposure dose rate limits are specified in the Japanese Industrial Standards (JIS) and by civil law at 50 mGy/min for usual fluoroscopy and 125 mGy/min for high-dose fluoroscopy. In the present study, we examined the difference in patient incident dose rate before and after using an X-ray generator that satisfied the above requirements. For incident dose to the image intensifier (I.I.), we investigated the differences between continuous and pulsed fluoroscopy, the effects of additional filters (Ta: tantalum, Al: aluminum), and the form of the X-ray spectrum. For pulsed fluoroscopy using PMMA (polymethyl-methacrylate), the maximum patient incident dose rates of usual and high-dose fluoroscopy were 59 mGy/min and 151 mGy/min, respectively. With regard to I.I. incident dose, saturation was observed beginning at a PMMA of 20 cm, and the X-ray dose was insufficient. In terms of the difference in patient incident dose rate with Ta and Al filters, the dose rate with the Ta filter was approximately 50% lower than that with the Al filter except for the saturation area. Concerning the X-ray spectrum, it was considered that a Ta filter not only minimizes patient X-ray exposure (because Ta reduces soft X-rays more effectively than Al) but also minimizes scattered X-rays because it filters out hard X-rays, leading to improved image quality. However, the use of the filter is appropriate only when a sufficient I.I. incident dose can be ensured. Specifically, the use of the filter under saturation conditions can lead to deterioration in image quality. Therefore, IVR X-ray systems must be equipped with an appropriate filter for reducing X-ray exposure while maintaining a sufficient I.I. incident dose rate.