Evaluation of image quality and patient exposure in fluoroscopy using a phantom: Is there any clinical relevance?

•Modern X-ray systems have numerous X-ray preset protocols; some are a “black box”.•X-ray system manufacturers offer more radiation optimization tools than in the past.•Protocol selection has large impact on image quality and patient radiation dose.•There are limitations on how software reproduces v...

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Published in:European journal of radiology Vol. 138; p. 109607
Main Authors: Tsalafoutas, I.A., Tsapaki, V., Triantopoulou, I.
Format: Journal Article
Language:English
Published: Ireland Elsevier B.V 01.05.2021
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ISSN:0720-048X, 1872-7727, 1872-7727
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Abstract •Modern X-ray systems have numerous X-ray preset protocols; some are a “black box”.•X-ray system manufacturers offer more radiation optimization tools than in the past.•Protocol selection has large impact on image quality and patient radiation dose.•There are limitations on how software reproduces visual image quality evaluations.•Performance of protocols under clinical conditions cannot be assessed by phantoms. To investigate the impact of X-ray preset acquisition protocol settings on fluoroscopy image quality (IQ) and radiation exposure. A quality control (QC) phantom was imaged with a modern digital C-arm system, using various preset fluoroscopy protocols. IQ was assessed using human observers and in-house software for automated evaluation, based on contrast-to-noise ratios of details and their background. Patient radiation exposure was evaluated using the displayed Incident Air-Kerma and Kerma-Area Product values. Protocol selection affects radiation exposure by a factor of about 3. IQ evaluation showed that acquisition protocols produce images with quite different characteristics. The visual IQ evaluation method was time consuming and cumbersome. The automated method, utilized the visual IQ evaluation results for calibration of detection thresholds. However, it failed to reproduce these results for all images and details types. In some images, digital image processing created artifacts which affected the pixel value distributions around details in a way that could be handled only by the human vision. Manufacturers provide many preset protocols designated for specific clinical uses, which have large impact on IQ characteristics and radiation exposure. However, protocol settings’ selection rationale is essentially a “black box” for the end user. Though QC phantoms are currently used for IQ evaluation, they are not appropriate for drawing firm conclusions concerning the expected performance of each protocol in clinical practice. Currently, there is no consensus on the optimum technical characteristics of preset protocols for specific procedures. More work is needed in this area.
AbstractList •Modern X-ray systems have numerous X-ray preset protocols; some are a “black box”.•X-ray system manufacturers offer more radiation optimization tools than in the past.•Protocol selection has large impact on image quality and patient radiation dose.•There are limitations on how software reproduces visual image quality evaluations.•Performance of protocols under clinical conditions cannot be assessed by phantoms. To investigate the impact of X-ray preset acquisition protocol settings on fluoroscopy image quality (IQ) and radiation exposure. A quality control (QC) phantom was imaged with a modern digital C-arm system, using various preset fluoroscopy protocols. IQ was assessed using human observers and in-house software for automated evaluation, based on contrast-to-noise ratios of details and their background. Patient radiation exposure was evaluated using the displayed Incident Air-Kerma and Kerma-Area Product values. Protocol selection affects radiation exposure by a factor of about 3. IQ evaluation showed that acquisition protocols produce images with quite different characteristics. The visual IQ evaluation method was time consuming and cumbersome. The automated method, utilized the visual IQ evaluation results for calibration of detection thresholds. However, it failed to reproduce these results for all images and details types. In some images, digital image processing created artifacts which affected the pixel value distributions around details in a way that could be handled only by the human vision. Manufacturers provide many preset protocols designated for specific clinical uses, which have large impact on IQ characteristics and radiation exposure. However, protocol settings’ selection rationale is essentially a “black box” for the end user. Though QC phantoms are currently used for IQ evaluation, they are not appropriate for drawing firm conclusions concerning the expected performance of each protocol in clinical practice. Currently, there is no consensus on the optimum technical characteristics of preset protocols for specific procedures. More work is needed in this area.
To investigate the impact of X-ray preset acquisition protocol settings on fluoroscopy image quality (IQ) and radiation exposure.OBJECTIVETo investigate the impact of X-ray preset acquisition protocol settings on fluoroscopy image quality (IQ) and radiation exposure.A quality control (QC) phantom was imaged with a modern digital C-arm system, using various preset fluoroscopy protocols. IQ was assessed using human observers and in-house software for automated evaluation, based on contrast-to-noise ratios of details and their background. Patient radiation exposure was evaluated using the displayed Incident Air-Kerma and Kerma-Area Product values.MATERIALS & METHODSA quality control (QC) phantom was imaged with a modern digital C-arm system, using various preset fluoroscopy protocols. IQ was assessed using human observers and in-house software for automated evaluation, based on contrast-to-noise ratios of details and their background. Patient radiation exposure was evaluated using the displayed Incident Air-Kerma and Kerma-Area Product values.Protocol selection affects radiation exposure by a factor of about 3. IQ evaluation showed that acquisition protocols produce images with quite different characteristics. The visual IQ evaluation method was time consuming and cumbersome. The automated method, utilized the visual IQ evaluation results for calibration of detection thresholds. However, it failed to reproduce these results for all images and details types. In some images, digital image processing created artifacts which affected the pixel value distributions around details in a way that could be handled only by the human vision.RESULTSProtocol selection affects radiation exposure by a factor of about 3. IQ evaluation showed that acquisition protocols produce images with quite different characteristics. The visual IQ evaluation method was time consuming and cumbersome. The automated method, utilized the visual IQ evaluation results for calibration of detection thresholds. However, it failed to reproduce these results for all images and details types. In some images, digital image processing created artifacts which affected the pixel value distributions around details in a way that could be handled only by the human vision.Manufacturers provide many preset protocols designated for specific clinical uses, which have large impact on IQ characteristics and radiation exposure. However, protocol settings' selection rationale is essentially a "black box" for the end user. Though QC phantoms are currently used for IQ evaluation, they are not appropriate for drawing firm conclusions concerning the expected performance of each protocol in clinical practice. Currently, there is no consensus on the optimum technical characteristics of preset protocols for specific procedures. More work is needed in this area.CONCLUSIONManufacturers provide many preset protocols designated for specific clinical uses, which have large impact on IQ characteristics and radiation exposure. However, protocol settings' selection rationale is essentially a "black box" for the end user. Though QC phantoms are currently used for IQ evaluation, they are not appropriate for drawing firm conclusions concerning the expected performance of each protocol in clinical practice. Currently, there is no consensus on the optimum technical characteristics of preset protocols for specific procedures. More work is needed in this area.
To investigate the impact of X-ray preset acquisition protocol settings on fluoroscopy image quality (IQ) and radiation exposure. A quality control (QC) phantom was imaged with a modern digital C-arm system, using various preset fluoroscopy protocols. IQ was assessed using human observers and in-house software for automated evaluation, based on contrast-to-noise ratios of details and their background. Patient radiation exposure was evaluated using the displayed Incident Air-Kerma and Kerma-Area Product values. Protocol selection affects radiation exposure by a factor of about 3. IQ evaluation showed that acquisition protocols produce images with quite different characteristics. The visual IQ evaluation method was time consuming and cumbersome. The automated method, utilized the visual IQ evaluation results for calibration of detection thresholds. However, it failed to reproduce these results for all images and details types. In some images, digital image processing created artifacts which affected the pixel value distributions around details in a way that could be handled only by the human vision. Manufacturers provide many preset protocols designated for specific clinical uses, which have large impact on IQ characteristics and radiation exposure. However, protocol settings' selection rationale is essentially a "black box" for the end user. Though QC phantoms are currently used for IQ evaluation, they are not appropriate for drawing firm conclusions concerning the expected performance of each protocol in clinical practice. Currently, there is no consensus on the optimum technical characteristics of preset protocols for specific procedures. More work is needed in this area.
ArticleNumber 109607
Author Tsapaki, V.
Tsalafoutas, I.A.
Triantopoulou, I.
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Keywords Image quality
Radiation exposure
Image artifacts
Image processing algorithms
Digital fluoroscopy
Language English
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Snippet •Modern X-ray systems have numerous X-ray preset protocols; some are a “black box”.•X-ray system manufacturers offer more radiation optimization tools than in...
To investigate the impact of X-ray preset acquisition protocol settings on fluoroscopy image quality (IQ) and radiation exposure. A quality control (QC)...
To investigate the impact of X-ray preset acquisition protocol settings on fluoroscopy image quality (IQ) and radiation exposure.OBJECTIVETo investigate the...
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StartPage 109607
SubjectTerms Digital fluoroscopy
Fluoroscopy
Humans
Image artifacts
Image processing algorithms
Image Processing, Computer-Assisted
Image quality
Phantoms, Imaging
Radiation Dosage
Radiation Exposure
Title Evaluation of image quality and patient exposure in fluoroscopy using a phantom: Is there any clinical relevance?
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https://dx.doi.org/10.1016/j.ejrad.2021.109607
https://www.ncbi.nlm.nih.gov/pubmed/33667936
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