Feasibility of optimized ultralow-dose pulsed fluoroscopy for upper gastrointestinal tract examinations: a phantom study with clinical correlation

• Published in: Radiologia medica 2017-11, Vol.122 (11), p.822-828
• Main Authors: Weiss, Jakob, Pomschar, Andreas, Rist, Carsten, Neumaier, Klement, Li, Minglun, Flatz, Wilhelm, Thierfelder, Kolja, Notohamiprodjo, Mike
• Format: Article
• Language: English
• Subjects: Abdominal Radiology; Correlation analysis; Diagnostic Radiology; Diagnostic systems; Dosimeters; Feasibility; Fluoroscopy; Image acquisition; Image contrast; Image quality; Imaging; Interventional Radiology; Medicine; Medicine & Public Health; Neuroradiology; Patients; Quality; Radiation dosage; Radiology; Reduction; Ultrasound
• ISSN: 0033-8362; 1826-6983
• DOI: 10.1007/s11547-017-0793-z

Purpose To establish an optimized ultralow-dose digital pulsed fluoroscopy (FP) protocol for upper gastrointestinal tract examinations and to investigate the radiation dose and image quality. Materials and methods An Alderson-Rando-Phantom with 60 thermoluminescent dosimeters was used for dose measurements to systematically evaluate the dose–area product (DAP) and organ doses of the optimized FP protocol with the following acquisition parameters: 86.7 kV; 77 mA; 0.9 mm 3 , automatic image noise and contrast adaption. Subjective image quality, depiction of contrast agent and image noise (5-point Likert scale; 5 = excellent) were assessed in 41 patients, who underwent contrast-enhanced FP with the aforementioned optimized protocol by two radiologists in consensus. A conventional digital radiograph (DR) acquisition protocol served as the reference standard for radiation dose and image quality analyses. Results Phantom measurements revealed a general dose reduction of approximately 96% per image for the FP protocol as compared to the DR standard. DAP could be reduced by 97%. Significant dose reductions were also found for organ doses, both in the direct and scattered radiation beam with negligible orbital (FP 5.6 × 10 −3 vs. DR 0.11; p  = 0.02) and gonadal dose exposure (female FP 2.4 × 10 −3 vs. DR 0.05; male FP 8 × 10 −4 vs. DR 0.03; p  ≤ 0.0004). FP provided diagnostic image quality in all patients, although reading scores were significantly lower for all evaluated parameters as compared to the DR standard ( p