Fluoroscopy Evaluation Guidelines for Detector Input Dose Settings - PDF document

Fluoroscopic Imaging Equipment Fluoroscopy Evaluation Guidelines for Detector Input Dose Settings and Image Optimization � Patient Dose � Image Quality RELATIVE EERD vs kVp 210% 200% Shimadzu Bransist - 22 cm FOV Direct Flat Panel Detector (Se/TFT) Detector Exposure Rate Normalized to Minimum 190% Philips Xper - 22 cm FOV Indirect Flat 180% Panel Detector (CsI(Tl)/TFT) 170% Siemens Artis Zee - 42 cm FOV Indirect Flat Panel Detector (CsI(Tl)/TFT) 160% Siemens Siregraph - 22 cm FOV X-ray 150% Image Intensifier Detector E n t r a n c e A r i K e r m a f 140% 1 4 M ( e a u s r o r 2 2 c m F O V 0 e d a t I n t e r v e n t o i 130% n a l R e f P o i n t ) No Grid-70 kV 10R AF 2kW 4ms/7 micro focus ms Note: Th i s one at 4 120% ) n 100kV 10 R AF 2kW smallfo 0 n Gy/pulse and 10 pps i 1 cus 110% m 2 0 No Grid-70kV 10 R AF 2kW 4 y / Note: Th micro focus ms/7ms G 80kV 10R 0302 3kW smallfocu i s one at 2 3 n Gy/pulse and 30 pps 100% m Note: Th i s one at 3 6 n Gy/pulse and 15 pps s ( 1 In so mea s. Dose was mu l tiplied by 2 90% e 0 0 terven tion al IQ 2 a t 80% 90 100 110 R 80kV 10R 0302 2kW smallfocu Note: Th s 60 70 80 so mea s. Dose i s one at 3 was mu 6 n Gy/pulse and 15 pps 40 50 m a 70kV 10R AF 2kW 5ms/8ms microfocu l tiplied by 2 kVp 8 0 s r e 80kV 10R AF 2kW smallfocus K r 80kV 10R 02 3kW small focus A i Phil Rauch 6 0 In terven e c tion al IQ 1 (no DHHS) n a 70kV 10R AF 2kW microfocus r t n 4 0 70kV Service 02 E t n 70kV 10R AF 3kW 6ms/9ms small focus e t i 70kV 10R AF 3kW 8ms/12ms smallfo a 2 0 cus Henry Ford Health Systems P 70kV 10R 02 3kW small focus 70kV 10R 02 2kW small focus 0 70kV 20R AF 3kW smallfocus 4 6 70kV 10R AF 3kW smallfocus 8 N o m i n a l P h a n 0 1 70kV 20R AF 3kW 8ms/12ms smallfo Detroit, MI o t m T h i c k n e s s ( n i cus c e h s ) 70kV Service 00 2009 AAPM Meeting-Phil Rauch 2009 AAPM Meeting-Phil Rauch Dose Reduction vs Image Quality Dose Reduction vs Image Quality � Dose reduction depends on…. � Image quality depends on…. ….technology ….technology ….proper equipment design ….proper equipment design ….proper set up of equipment parameters ….proper set up of equipment parameters ….proper utilization of the equipment ….proper utilization of the equipment ….knowledge and skill of the radiologist ….knowledge and skill of the radiologist 2009 AAPM Meeting-Phil Rauch 2009 AAPM Meeting-Phil Rauch 1

What is the Patient Dose? What is the Exam Protocol? What is the exam protocol? 2009 AAPM Meeting-Phil Rauch 2009 AAPM Meeting-Phil Rauch Entrance Air Kerma for 22 cm FOV Entrance Air Kerma for 22 cm FOV No Grid-70 kV 10R AF 2kW 4ms/7ms No Grid-70 kV 10R AF 2kW 4ms/7ms microfocus microfocus (Measured at Interventional Ref Point) Note: This one at 40 nGy/pulse and 10 pps (Measured at Interventional Ref Point) Note: This one at 40 nGy/pulse and 10 pps 100kV 10R AF 2kW smallfocus 100kV 10R AF 2kW smallfocus 140 140 No Grid-70kV 10R AF 2kW 4ms/7ms No Grid-70kV 10R AF 2kW 4ms/7ms microfocus microfocus Note: This one at 23 nGy/pulse and 30 pps Low doses for this protocol may be Note: This one at 23 nGy/pulse and 30 pps Patient Entrance Air Kerma Rate (mGy/min) 80kV 10R 0302 3kW smallfocus Patient Entrance Air Kerma Rate (mGy/min) 80kV 10R 0302 3kW smallfocus Note: This one at 36 nGy/pulse and 15 pps Note: This one at 36 nGy/pulse and 15 pps 120 Patient dose (and image quality) are highly so meas. Dose was multiplied by 2 120 appropriate for pediatric imaging so meas. Dose was multiplied by 2 Interventional IQ 2 Interventional IQ 2 dependent on the exam protocol setting 80kV 10R 0302 2kW smallfocus 80kV 10R 0302 2kW smallfocus Note: This one at 36 nGy/pulse and 15 pps Note: This one at 36 nGy/pulse and 15 pps so meas. Dose was multiplied by 2 so meas. Dose was multiplied by 2 100 100 70kV 10R AF 2kW 5ms/8ms microfocus 70kV 10R AF 2kW 5ms/8ms microfocus 80kV 10R AF 2kW smallfocus 80kV 10R AF 2kW smallfocus 80kV 10R 02 3kW smallfocus 80kV 10R 02 3kW smallfocus 80 80 FDA Limit FDA Limit Interventional IQ 1 (no DHHS) Interventional IQ 1 (no DHHS) 70kV 10R AF 2kW microfocus 70kV 10R AF 2kW microfocus 60 60 70kV Service 02 70kV Service 02 70kV 10R AF 3kW 6ms/9ms smallfocus 70kV 10R AF 3kW 6ms/9ms smallfocus 40 40 70kV 10R AF 3kW 8ms/12ms smallfocus 70kV 10R AF 3kW 8ms/12ms smallfocus 70kV 10R 02 3kW smallfocus 70kV 10R 02 3kW smallfocus 70kV 10R 02 2kW smallfocus 70kV 10R 02 2kW smallfocus 20 20 70kV 20R AF 3kW smallfocus 70kV 20R AF 3kW smallfocus 70kV 10R AF 3kW smallfocus 70kV 10R AF 3kW smallfocus 0 0 70kV 20R AF 3kW 8ms/12ms smallfocus 70kV 20R AF 3kW 8ms/12ms smallfocus 4 6 8 10 4 6 8 10 70kV Service 00 70kV Service 00 Nominal Phantom Thickness (inches) Nominal Phantom Thickness (inches) 2009 AAPM Meeting-Phil Rauch 2009 AAPM Meeting-Phil Rauch 2

Image Quality Assessment Entrance Air Kerma for 22 cm FOV No Grid-70 kV 10R AF 2kW 4ms/7ms microfocus (Measured at Interventional Ref Point) Note: This one at 40 nGy/pulse and 10 pps 100kV 10R AF 2kW smallfocus 140 No Grid-70kV 10R AF 2kW 4ms/7ms microfocus Settings optimized for low Note: This one at 23 nGy/pulse and 30 pps 80kV 10R 0302 3kW smallfocus Patient Entrance Air Kerma Rate (mGy/min) Note: This one at 36 nGy/pulse and 15 pps 120 so meas. Dose was multiplied by 2 dose pediatric imaging may Interventional IQ 2 80kV 10R 0302 2kW smallfocus not be appropriate for adults Note: This one at 36 nGy/pulse and 15 pps so meas. Dose was multiplied by 2 100 70kV 10R AF 2kW 5ms/8ms microfocus 80kV 10R AF 2kW smallfocus 80kV 10R 02 3kW smallfocus 80 FDA Limit Interventional IQ 1 (no DHHS) 70kV 10R AF 2kW microfocus 60 70kV Service 02 70kV 10R AF 3kW 6ms/9ms smallfocus 40 70kV 10R AF 3kW 8ms/12ms smallfocus 70kV 10R 02 3kW smallfocus 70kV 10R 02 2kW smallfocus 20 70kV 20R AF 3kW smallfocus 70kV 10R AF 3kW smallfocus 0 70kV 20R AF 3kW 8ms/12ms smallfocus 4 6 8 10 70kV Service 00 Nominal Phantom Thickness (inches) 2009 AAPM Meeting-Phil Rauch 2009 AAPM Meeting-Phil Rauch Image Quality Assessment Image Quality Assessment Descriptors Evaluation (HVS) Contrast Edge Noise Detection Sharpness Pattern Recognition Saturation Comparison Artifacts Assessment Relevance Conclusion 2009 AAPM Meeting-Phil Rauch 2009 AAPM Meeting-Phil Rauch 3

Is Pulse Width Important? Is Pulse Width Important? 2009 AAPM Meeting-Phil Rauch 2009 AAPM Meeting-Phil Rauch Fluoroscopic Image Quality Exposure ON-time – Pulsed vs Cont Image Intensifier Blur (Frame integration Time) Flat Panel Pulsed Fluoro* Continuous Fluoro* (30 pulses per sec) (30 video frames per sec) *Displayed at 7.5 fps *Displayed at 7.5 fps 2009 AAPM Meeting-Phil Rauch 2009 AAPM Meeting-Phil Rauch 4

Fluoroscopic Image Quality Fluoroscopic Image Quality Image Intensifier Image Intensifier Frame Frame L L A A integration G integration G ( ( S S i g i g n n a a l l r e r e time t time t e e n n t i t i o o n n ) ) Flat Panel Flat Panel R e c u r s i v f e i l t e r s e t t i n g 2009 AAPM Meeting-Phil Rauch 2009 AAPM Meeting-Phil Rauch Blur versus Recursive Filtering Blur versus Recursive Filtering Continuous Fluoroscopy Pulsed Fluoroscopy Continuous Fluoroscopy Pulsed Fluoroscopy With Recursive Filtering With Recursive Filtering Without Recursive Filtering Without Recursive Filtering 2009 AAPM Meeting-Phil Rauch 2009 AAPM Meeting-Phil Rauch 5

Fluoroscopic Image Quality Perceptual Integration Image Intensifier Frame Where are the 3’s L A integration G ( S i g n a l r e time t e n t i o n ) Flat Panel R l e a u c u t r p s i e n v c o f e i r t i l t e e P a r r g s e e t t t n i n i g 2009 AAPM Meeting-Phil Rauch 2009 AAPM Meeting-Phil Rauch Perceptual Integration Perceptual Integration Where are the 3’s Where are the 3’s 30 Frames/sec 8 Frames/sec 2009 AAPM Meeting-Phil Rauch 2009 AAPM Meeting-Phil Rauch 6