Fluoroscopic imaging is utilized to dynamically image a patient’s internal anatomy and physiology during an examination. Current methods for the evaluation of fluoroscopic image performance do not challenge systems in real- time or with clinically meaningful tasks. This work presents a methodology for the task-specific quantification of clinical fluoroscopy systems’ imaging performance, through reader assessments of live fluoroscopic images. First, a set of clinically relevant tasks was developed based on the internationally recognized grading scale for kidney-ureter vesicoureteric reflux (VUR) in pediatric patients. Tasks were generated to represent VUR grades from 2 to 5, and were printed using iodine ink 2D printing. Tasks were described by the total number of pages, i.e. total iodine contrast, and the VUR grade of the task itself. In total, 24 combinations of contrast and grade were assessed. Images of each task were taken under three experimental conditions: first, under a high-dose flat panel detector clinical system; second, under a low-dose protocol on the same flat panel detector system; and third, under a comparable high-dose protocol in an image intensifier clinical system. Readers assessed imaging tasks in the clinical environment in two manners: 1) detection (VUR present or absent), and 2) identification of the VUR grade. The results of the reader study indicate that after the application of a scoring scheme, a metric quantifying task-performance of fluoroscopy systems may be obtained. The evaluation process outlined in this work will enable a standard mechanism for the quantitative comparison across fluoroscopic systems, technologies, and protocols.
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