The detectors that are used for endovascular image-guided interventions (EIGI), particularly for neurovascular
interventions, do not provide clinicians with adequate visualization to ensure the best possible treatment outcomes.
Developing an improved x-ray imaging detector requires the determination of estimated clinical x-ray entrance
exposures to the detector. The range of exposures to the detector in clinical studies was found for the three modes of
operation: fluoroscopic mode, high frame-rate digital angiographic mode (HD fluoroscopic mode), and DSA mode.
Using these estimated detector exposure ranges and available CMOS detector technical specifications, design
requirements were developed to pursue a quantum limited, high resolution, dynamic x-ray detector based on a CMOS
sensor with 50 μm pixel size. For the proposed MAF-CMOS, the estimated charge collected within the full exposure
range was found to be within the estimated full well capacity of the pixels. Expected instrumentation noise for the
proposed detector was estimated to be 50-1,300 electrons. Adding a gain stage such as a light image intensifier would
minimize the effect of the estimated instrumentation noise on total image noise but may not be necessary to ensure
quantum limited detector operation at low exposure levels. A recursive temporal filter may decrease the effective total
noise by 2 to 3 times, allowing for the improved signal to noise ratios at the lowest estimated exposures despite
consequent loss in temporal resolution. This work can serve as a guide for further development of dynamic x-ray
imaging prototypes or improvements for existing dynamic x-ray imaging systems.