Biplane interventional pediatric system with cone-beam CT: dose and image quality characterization for the default protocols

Physical Image Quality Metrics for the Characterization of X-ray Systems Used in Fluoroscopy-Guided Pediatric Cardiac Interventional Procedures: A Systematic Review

Pediatric interventional cardiology procedures are essential in diagnosing and treating congenital heart disease in children; however, they raise concerns about potential radiation exposure. Managing radiation doses and assessing image quality in angiographs becomes imperative for safe and effective interventions. This systematic review aims to comprehensively analyze the current understanding of physical image quality metrics relevant for characterizing X-ray systems used in fluoroscopy-guided pediatric cardiac interventional procedures, considering the main factors reported in the literature that influence this outcome. A search in Scopus and Web of Science, using relevant keywords and inclusion/exclusion criteria, yielded 14 relevant articles published between 2000 and 2022. The physical image quality metrics reported were noise, signal-to-noise ratio, contrast, contrast-to-noise ratio, and high-contrast spatial resolution. Various factors influencing image quality were investigated, such as polymethyl methacrylate thickness (often used to simulate water equivalent tissue thickness), operation mode, anti-scatter grid presence, and tube voltage. Objective evaluations using these metrics ensured impartial assessments for main factors affecting image quality, improving the characterization of fluoroscopic X-ray systems, and aiding informed decision making to safeguard pediatric patients during procedures.

Assessment of volumetric absorbed dose for mobile fluoroscopic 3D image acquisition

Mobile fluoroscopy (c‐arm) units offering 3D image reconstruction are becoming more common in surgical settings. Although these images are “CT‐like” and sometimes replace the postoperative CT, the acquisition is technically very different from a traditional CT acquisition. Dose assessment is complicated by a large beam width, automatic exposure rate control, and a rotation of less than 360°. The purpose of this work was to explore the impact of these factors on the volumetric dose calculation and to provide practical recommendations for clinical physicists assessing dose from these units using commonly available equipment. CTDI_W was calculated using the IAEA method for dosimetry of wide beams and compared to scans of the 32‐cm CTDI phantom using the full beam width and a 20‐mm collimated beam width. The impact of the partial rotation on the CTDI_W calculation was assessed by acquiring measurements at four and twelve positions on the phantom periphery. For the system tested, the CTDI_W was calculated to be 16.1 mGy using the IAEA method with default clinical protocol. Results showed that measuring CTDI_W with the full beam width or a collimated beam width alone resulted in CTDI values of 19.0 mGy and 19.5 mGy, respectively. Using four peripheral measurements instead of 12 resulted in a difference of 4% for a collimated beam and 6% for an open beam. Variations in positioning on the order of a few centimeters resulted in a variation of only 4% with an open beam. The excellent reproducibility of the measurements using the full beam width suggests that this simple method is adequate for year‐to‐year comparisons. In contrast, the IAEA method is difficult to employ, particularly with 180° acquisitions. Use of peripheral measurements in excess of the usual four is time‐consuming and not necessary for most applications obtained with the geometry specific to this system.

Eye lens dose correlations with personal dose equivalent and patient exposure in paediatric interventional cardiology performed with a fluoroscopic biplane system

PURPOSE

To analyse the correlations between the eye lens dose estimates performed with dosimeters placed next to the eyes of paediatric interventional cardiologists working with a biplane system, the personal dose equivalent measured on the thorax and the patient dose.

METHODS

The eye lens dose was estimated in terms of H_p(0.07) on a monthly basis, placing optically stimulated luminescence dosimeters (OSLDs) on goggles. The H_p(0.07) personal dose equivalent was measured over aprons with whole-body OSLDs. Data on patient dose as recorded by the kerma-area product (P_KA) were collected using an automatic dose management system. The 2 paediatric cardiologists working in the facility were involved in the study, and 222 interventions in a 1-year period were evaluated. The ceiling-suspended screen was often disregarded during interventions.

RESULTS

The annual eye lens doses estimated on goggles were 4.13±0.93 and 4.98±1.28mSv. Over the aprons, the doses obtained were 10.83±0.99 and 11.97±1.44mSv. The correlation between the goggles and the apron dose was R²=0.89, with a ratio of 0.38. The correlation with the patient dose was R²=0.40, with a ratio of 1.79μSvGy^-1cm^-2. The dose per procedure obtained over the aprons was 102±16μSv, and on goggles 40±9μSv. The eye lens dose normalized to P_KA was 2.21±0.58μSvGy^-1cm^-2.

CONCLUSIONS

Measurements of personal dose equivalent over the paediatric cardiologist's apron are useful to estimate eye lens dose levels if no radiation protection devices are typically used.