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Lin PJP, Goode AR, Corwin FD, Fisher RF, Balter S, Wunderle KA, Schueler BA, Kim DS, Zhang J, Zhou YJ, Jenkins PA, Mahmood U, Lin T, Zhao H, Park MA, Trianni A, Lendle M, Kuhls-Gilcrist A, Jans JC, Desponds L, Banasiak G, Backes S, Snyder C, Snyder A, Lu M, Gonzalez S. Report of AAPM Task Group 272: Comprehensive acceptance testing and evaluation of fluoroscopy imaging systems. Med Phys 2022; 49:e1-e49. [PMID: 35032394 DOI: 10.1002/mp.15429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 11/06/2022] Open
Abstract
Modern fluoroscopes used for image guidance have become quite complex. Adding to this complexity are the many regulatory and accreditation requirements that must be fulfilled during acceptance testing of a new unit. Further, some of these acceptance tests have pass/fail criteria, while others do not, making acceptance testing a subjective and time consuming task. The AAPM Task Group 272 Report spells out the details of tests that are required and gives visibility to some of the tests that while not yet required, are recommended as good practice. The organization of the report begins with the most complicated fluoroscopes used in interventional radiology or cardiology, continues with general fluoroscopy and mobile C-arms. Finally, the Appendices of the report provide useful information, an example report form and topics that needed their own section due to the level of detail. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Pei-Jan Paul Lin
- Department of Radiology, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Allen R Goode
- Department of Radiology, University of Virginia, Charlottesville, VA, 22908, USA
| | - Frank D Corwin
- Department of Radiology, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Ryan F Fisher
- Department of Radiology, The MetroHealth System, Cleveland, OH, 44109, USA
| | - Stephen Balter
- Departments of Medicine and Radiology, Columbia University Medical Center, New York, NY, 10021, USA
| | - Kevin A Wunderle
- Department of Radiology, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Beth A Schueler
- Radiology Department, Mayo Clinic, Rochester, MN, 55905, USA
| | - Don-Soo Kim
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Jie Zhang
- Department of Radiology, University of Kentucky, Lexington, KY, 40536, USA
| | - Yifang Jimmy Zhou
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Peter A Jenkins
- Department of Radiology, University of Utah Health, Salt Lake City, UT, 84132, USA
| | - Usman Mahmood
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Teh Lin
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, 19111, USA
| | - Hui Zhao
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT, 84112, USA
| | - Mi-Ae Park
- Department of Radiology, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Annalisa Trianni
- Medical Physics Department, Udine University Hospital, Udine, 33100, Italy
| | | | | | - Jan C Jans
- Philips Healthcare, Best, 5680 DA, The Netherlands
| | | | | | - Steve Backes
- Atirix Medical Systems, Inc., Minneapolis, MN, 55305, USA
| | - Carl Snyder
- Atirix Medical Systems, Inc., Minneapolis, MN, 55305, USA
| | - Angela Snyder
- Atirix Medical Systems, Inc., Minneapolis, MN, 55305, USA
| | - Minghui Lu
- Varex Imaging Corporation, San Jose, CA, 95134, USA
| | - Scott Gonzalez
- Food and Drug Administration, Health and Human Services, Silver Spring, MD, 20993, USA
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Konst B, Nøtthellen J, Bilet E, Båth M. Radiographic and fluoroscopic X-ray systems: Quality control of the X-ray tube and automatic exposure control using theoretical spectra to determine air kerma and dose to a homogenous phantom. J Appl Clin Med Phys 2021; 22:204-218. [PMID: 34196461 PMCID: PMC8364276 DOI: 10.1002/acm2.13329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/26/2021] [Accepted: 05/26/2021] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To develop a method to perform quality control (QC) of X-ray tubes and automatic exposure control (AEC) as a part of the QC of the radiographic and fluoroscopic X-ray system. Our aim is to verify the output from the X-ray tube by comparing the measured radiation output, or air kerma, to the theoretical output given the applied exposure settings and geometry, in addition to comparing the measured kV to the nominal kV. The AEC system for fluoroscopic and conventional X-ray systems is assessed by determining the absorbed dose to a homogenous phantom with different thicknesses. METHOD This study presents a model to verify the X-ray tube measurement results and a method to determine the dose to a homogenous phantom (Dphantom ). The following input is needed: a parameterized model of the X-ray spectrum, the X-ray tube measurements using a multifunctional X-ray meter, the exposure parameters recorded via imaging of polymethyl methacrylate (PMMA) slabs of different thickness that simulate the patient using AEC, and a parameterized model for calculating the dose to water from Monte Carlo simulations. The output is the entrance surface dose (ESD) and absorbed dose in the phantom, Dphantom (µGy). In addition, the parameterized X-ray spectrum is used to compare theoretical and measured air kerma as a part of the QC of the X-ray tube. To verify the proposed method, the X-ray spectrum provided in this study, SPECTRUM, was compared to two commercially available spectra, SpekCalc and Institute of Physics and Engineering in Medicine (IPEM) 78. The fraction of energy imparted to the homogenous phantom was compared to the imparted fraction calculated by PCXMC. RESULTS The spectrum provided in this study was in good agreement with two previously published X-ray spectra. The absolute percentage differences of the spectra varied from 0.05% to 3.9%, with an average of 1.4%, compared to SpekCalc. Similarly, the deviation from IPEM report 78 varied from 0.02% to 2.3%, with an average of 0.74%. The SPECTRUM was parameterized for calculation of the imparted fraction for target angles of 10°, 12°, and 15°, kV (50-150 kV) with the materials Al (2.2-8 mm), Cu (0-1 mm), and any combination of the filters, PMMA and water. The deviation of energy imparted from the results by PCXMC was less than 8% for all measurements across different kV, filtration, and vendors, obtained by using PMMA to record the exposure parameters, while the dose was calculated based on water with same thicknesses as the PMMA. CONCLUSION This study presents an accurate and suitable method to perform a part of the QC of fluoroscopic and conventional X-ray systems with respect to the X-ray tube and the associated AEC system. The method is suitable for comparing protocols within and between systems via the absorbed dose.
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Affiliation(s)
- Bente Konst
- Department of RadiologyVestfold Hospital TrustTønsbergNorway
- Faculty of Mathematics and Natural SciencesDepartment of PhysicsUniversity of OsloOsloNorway
| | - Jacob Nøtthellen
- Division of Diagnostics and InterventionOslo University HospitalOsloNorway
| | - Ellinor Bilet
- Norwegian Hospital Construction AgencyTrondheimNorway
| | - Magnus Båth
- Department of Medical Physics and Biomedical EngineeringSahlgrenska University HospitalGothenburgSweden
- Department of Radiation PhysicsInstitute of Clinical SciencesSahlgrenska Academy at University of GothenburgGothenburgSweden
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Shaw D, Worrall M, Baker C, Charnock P, Fazakerley J, Honey I, Iball G, Koutalonis M, Price M, Renaud C, Rose A, Wood T. IPEM Topical Report: An evidence and risk assessment based analysis of the efficacy of quality assurance tests on fluoroscopy units-part II; image quality. Phys Med Biol 2020; 65:225037. [PMID: 32937602 DOI: 10.1088/1361-6560/abb92f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This work aims to assess the efficacy of x-ray quality assurance tests undertaken on fluoroscopy units in the UK. Information was gathered on the results of image quality tests recommended by the reports of the Institute of Physics and Engineering in Medicine, and those additionally undertaken by medical physics departments. The assessment of efficacy considers the frequency with which a test result breaches the remedial level or other relevant threshold where applicable. The third quartile of those results exceeding the remedial level or threshold is used to estimate the severity of such a breach in terms of potential impact on patient dose and image quality. A risk assessment approach is then used to recommend to what degree, if any, the test should be included in an on-going test regimen. Data was analysed from 469 testing sessions to 337 unique fluoroscopy units throughout the UK. Across all tests, the rate with which the remedial level was exceeded varied from 0-10.6%, with severity ranging from little or none to major degradation to image quality or significant increase on population dose. Where possible, the data has also been used to produce representative ranges for the results of image quality tests. These could be useful as an up to date comparator for those sites considering the purchase of or commissioning new equipment. Overall the results indicate a wide range for the efficacy of those tests undertaken at present; this can be used to review local test protocols and to inform future changes to national guidance in the UK. The results also highlight some tests where measurement technique varies significantly throughout the UK, making any valid comparison difficult. This may indicate a need for further guidance on how best to undertake these tests.
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Affiliation(s)
- Dan Shaw
- The Christie NHS Foundation Trust, Manchester, United Kingdom
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The American College of Radiology Fluoroscopy Dose Index Registry Pilot: Technical Considerations and Dosimetric Performance of the Interventional Fluoroscopes. J Vasc Interv Radiol 2020; 31:1545-1550.e1. [PMID: 32861568 DOI: 10.1016/j.jvir.2020.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/23/2020] [Accepted: 04/23/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To characterize the accuracy and consistency of fluoroscope dose index reporting and report rates of occupational radiation safety hardware availability and use, trainee participation in procedures, and optional hardware availability at pilot sites for the American College of Radiology (ACR) Fluoroscopy Dose Index Registry (DIR). MATERIALS AND METHODS Nine institutions participated in the registry pilot, providing fluoroscopic technical and clinical practice data from 38 angiographic C-arm-type fluoroscopes. These data included measurements of the procedure table and mattress transmission factors and accuracy measurements of the reference-point air kerma (Ka,r) and air kerma-area product (PKA). The accuracy of the radiation dose indices were analyzed for variation over time by 1-way analysis of variance (ANOVA). Sites also self-reported information on availability and use of radiation safety hardware, hardware configuration of fluoroscopes, and trainee participation in procedures. RESULTS All Ka,r and PKA measurements were within the ±35% regulatory limit on accuracy. The mean absolute difference between correction factors for a given system in fluoroscopic and acquisition mode was 0.03 (95% confidence interval, 0.03-0.03). For the 28 fluoroscopic imaging planes that provided data for 3 time points, ANOVA yielded an F value of 0.134 with an F-critical value of 3.109 (P = .875). CONCLUSIONS This publication provides the technical and clinical framework pertaining to the ACR Fluoroscopy DIR pilot and offers necessary context for future analysis of the clinical procedure radiation-dose data collected.
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