Purpose The aim of this work was to measure image quality in terms of the square of the accumulation rate of the signal to noise ratio of low-contrast details, SNR rate 2 , kerma area product rate, P KA , rate and to quantify dose efficiency, SNR rate 2 / P KA , rate on a modern fluoroscopy system while varying the imaging conditions such as contrast detail size, X-ray beam size, dose rate, and object thickness. Methods The methodology derived by Tapiovaara et al. (Phys. Med. Biol., 38, 1761–1788, 1993, and STUK-A196, 2003) was used and implemented in MatlabTM. Measurement of model observer SNR rate 2 and P KA , rate were derived from stored fluoroscopy image sequences and the built-in kerma-area product reading on a Siemens Axiom Artis Zee MP system, respectively. 1024 image frames with and without the contrast detail were stored and subsequently analyzed by a model observer. SNR was calculated from the mean and standard deviation of the distributions of the decision variable. Finally, the long-term stability of the imaging system in terms of dose efficiency and the usefulness of the method as a quality control measure was evaluated. Results The precision in SNR rate 2 estimate was proportional to the inverse square root of the number of frames and SNR rate 2 was proportional to the area and squared thickness of the low-contrast detail. The dose efficiency increased with a factor of three with decreasing X-ray beam size from 242 cm2 to 182 cm2 and object thickness from 25 cm to 20 cm, hence quantifying the large dose efficiency gains by collimation and compression. The dose efficiency increased by 50% using the reduced dose rate compared to high dose rate. While the long-term stability of dose efficiency was measured with an uncertainty of ± 8%, the method is presently too time-consuming for routine quality control, mainly due to the slow data transfer of the large data files to the analysis server. Conclusions The results of the dose efficiency measurements under varying imaging conditions, agree with common radiological protection knowledge and allows changes in dose efficiency to be quantified which facilitate dose optimization in interventional procedures.
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