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Chapter 14:
Quantitative Image Quality Studies and the Design of X-Ray Fluoroscopy Systems
X-ray fluoroscopy is a medical-imaging technique whereby low-dose high-acquisition-rate x-ray images are obtained [1, 2]. Fluoroscopy provides quantum-limited high-definition digital-television viewing of structures inside the body. It makes possible many minimally invasive treatments such as balloon angioplasty, neuroembolizations, and transjugular intrahepatic portosystemic shunts (TIPS). Despite many recent developments in MR and CT imaging, x-ray fluoroscopy remains the principal imaging method for image-guided therapy. Although the x-ray dose per acquisition is low, very long sessions of fluoroscopy are required during complex interventional procedures giving relatively large doses to patients and operators [3]. Procedures lasting 4 hours with fluoroscopy times over 100 minutes are documented [4, 5], and some interventional neuroangiography procedures last 8 to 12 hours with fluoroscopy times exceeding 75 min [6]. The FDA has documented reports of severe skin injury [7, 8]. In a public health advisory, the FDA warns of “… occasional, but sometimes severe radiation-induced skin injuries to patients resulting from prolonged, fluoroscopically-guided, invasive procedures.” The advisory points out that injury can occur after less than one hour of fluoroscopy at normal exposure rates of 2 to 5 rad/ˆ•min [9]. Such exposures are easily reached in complex procedures. Hence, on average fluoroscopy accounts for one half of the population diagnostic x-ray dose [10] and for exceptionally large doses to those patients getting the most intricate procedures.
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