Variability in radiation dose and image quality: A comparison across fluoroscopy-system vendors, generations of equipment and institutions

Kevin D. Hill, Steve D. Mann, Michael P. Carboni, Thomas P. Doyle, Salim F. Idriss, Dana F. Janssen, George T. Nicholson, Shyam Sathanandam, Greg A. Fleming

Research output: Contribution to journalArticle

Abstract

Objectives: To evaluate differences in radiation dose and image quality across institutions, fluoroscope vendors and generations of fluoroscopes for pediatric cardiac catheterization. Background: Increased recognition of the potentially harmful effects of ionizing radiation has spurred technological advances in fluoroscopes, as well as increased focus on optimizing fluoroscope performance. There is currently little understanding of variability in the dose–image quality relationship across institutions, fluoroscope vendor and/or generation of equipment. Methods: We evaluated latest generation fluoroscopes from Phillips, Siemens, GE, and Toshiba, and an older generation Phillips fluoroscope (release date 2003) at three different institutions. Radiation dose was measured using an anthropomorphic dose-assessment phantom with effective dose in mSv estimated from Monte Carlo simulations. Image quality phantom images were scored on a 12-point scale by three blinded reviewers. Results: Fluoroscope effective doses ranged from 0.04 to 0.14 mSv/1,000 pulses for fluoroscopy with associated composite image quality scores ranging from 8.0 ± 0.6 to 10.4 ± 1.3. For cineangiography, effective doses ranged from 0.17 to 0.57 mSv/1,000 frames with image quality scores ranging from 10.1 ± 0.3 to 11.1 ± 0.3. There was modest correlation between effective dose and image quality (r = 0.67, P = 0.006). The older generation fluoroscope delivered consistently higher doses than the newer generation systems (2.3- to 3.5-fold higher for fluoroscopy; 1.1- to 3.4-fold higher for cineangiography) without appreciable differences in image quality. Conclusion: Technological advances have markedly improved fluoroscope performance. Comparing latest generation systems across vendors and institutions, we found variability in the dose–IQ relationship and speculate that this reflects both equipment and institutional optimization practices.

Original languageEnglish (US)
Pages (from-to)E471-E477
JournalCatheterization and Cardiovascular Interventions
Volume92
Issue number7
DOIs
StatePublished - Dec 1 2018

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Fluoroscopy
Cineangiography
Radiation
Equipment and Supplies
Institutional Practice
Cardiac Catheterization
Ionizing Radiation
Pediatrics

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Variability in radiation dose and image quality : A comparison across fluoroscopy-system vendors, generations of equipment and institutions. / Hill, Kevin D.; Mann, Steve D.; Carboni, Michael P.; Doyle, Thomas P.; Idriss, Salim F.; Janssen, Dana F.; Nicholson, George T.; Sathanandam, Shyam; Fleming, Greg A.

In: Catheterization and Cardiovascular Interventions, Vol. 92, No. 7, 01.12.2018, p. E471-E477.

Research output: Contribution to journalArticle

Hill, Kevin D. ; Mann, Steve D. ; Carboni, Michael P. ; Doyle, Thomas P. ; Idriss, Salim F. ; Janssen, Dana F. ; Nicholson, George T. ; Sathanandam, Shyam ; Fleming, Greg A. / Variability in radiation dose and image quality : A comparison across fluoroscopy-system vendors, generations of equipment and institutions. In: Catheterization and Cardiovascular Interventions. 2018 ; Vol. 92, No. 7. pp. E471-E477.
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abstract = "Objectives: To evaluate differences in radiation dose and image quality across institutions, fluoroscope vendors and generations of fluoroscopes for pediatric cardiac catheterization. Background: Increased recognition of the potentially harmful effects of ionizing radiation has spurred technological advances in fluoroscopes, as well as increased focus on optimizing fluoroscope performance. There is currently little understanding of variability in the dose–image quality relationship across institutions, fluoroscope vendor and/or generation of equipment. Methods: We evaluated latest generation fluoroscopes from Phillips, Siemens, GE, and Toshiba, and an older generation Phillips fluoroscope (release date 2003) at three different institutions. Radiation dose was measured using an anthropomorphic dose-assessment phantom with effective dose in mSv estimated from Monte Carlo simulations. Image quality phantom images were scored on a 12-point scale by three blinded reviewers. Results: Fluoroscope effective doses ranged from 0.04 to 0.14 mSv/1,000 pulses for fluoroscopy with associated composite image quality scores ranging from 8.0 ± 0.6 to 10.4 ± 1.3. For cineangiography, effective doses ranged from 0.17 to 0.57 mSv/1,000 frames with image quality scores ranging from 10.1 ± 0.3 to 11.1 ± 0.3. There was modest correlation between effective dose and image quality (r = 0.67, P = 0.006). The older generation fluoroscope delivered consistently higher doses than the newer generation systems (2.3- to 3.5-fold higher for fluoroscopy; 1.1- to 3.4-fold higher for cineangiography) without appreciable differences in image quality. Conclusion: Technological advances have markedly improved fluoroscope performance. Comparing latest generation systems across vendors and institutions, we found variability in the dose–IQ relationship and speculate that this reflects both equipment and institutional optimization practices.",
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T2 - A comparison across fluoroscopy-system vendors, generations of equipment and institutions

AU - Hill, Kevin D.

AU - Mann, Steve D.

AU - Carboni, Michael P.

AU - Doyle, Thomas P.

AU - Idriss, Salim F.

AU - Janssen, Dana F.

AU - Nicholson, George T.

AU - Sathanandam, Shyam

AU - Fleming, Greg A.

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AB - Objectives: To evaluate differences in radiation dose and image quality across institutions, fluoroscope vendors and generations of fluoroscopes for pediatric cardiac catheterization. Background: Increased recognition of the potentially harmful effects of ionizing radiation has spurred technological advances in fluoroscopes, as well as increased focus on optimizing fluoroscope performance. There is currently little understanding of variability in the dose–image quality relationship across institutions, fluoroscope vendor and/or generation of equipment. Methods: We evaluated latest generation fluoroscopes from Phillips, Siemens, GE, and Toshiba, and an older generation Phillips fluoroscope (release date 2003) at three different institutions. Radiation dose was measured using an anthropomorphic dose-assessment phantom with effective dose in mSv estimated from Monte Carlo simulations. Image quality phantom images were scored on a 12-point scale by three blinded reviewers. Results: Fluoroscope effective doses ranged from 0.04 to 0.14 mSv/1,000 pulses for fluoroscopy with associated composite image quality scores ranging from 8.0 ± 0.6 to 10.4 ± 1.3. For cineangiography, effective doses ranged from 0.17 to 0.57 mSv/1,000 frames with image quality scores ranging from 10.1 ± 0.3 to 11.1 ± 0.3. There was modest correlation between effective dose and image quality (r = 0.67, P = 0.006). The older generation fluoroscope delivered consistently higher doses than the newer generation systems (2.3- to 3.5-fold higher for fluoroscopy; 1.1- to 3.4-fold higher for cineangiography) without appreciable differences in image quality. Conclusion: Technological advances have markedly improved fluoroscope performance. Comparing latest generation systems across vendors and institutions, we found variability in the dose–IQ relationship and speculate that this reflects both equipment and institutional optimization practices.

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