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X-Ray Fluoroscopy Imaging in the Invasive Cardiac Laboratory: Medical Physics Support of a Contemporary Practice

Kenneth Fetterly

K Fetterly1*, (1) Mayo Clinic, Rochester, MN

MO-B-Salon BCD-1 Monday 10:00:00 AM - 12:00:00 PM Room: Salon BCD

While there are several imaging technologies that are used to diagnose and treat cardiovascular disease, x-ray fluoroscopy remains the primary modality used for guidance during invasive cardiovascular procedures. From the clinical perspective, fluoroscopy system quality is a combination of image quality and patient radiation dose. Image resolution, contrast, and noise are highly variable between systems and operational modes. Patient radiation skin dose is a principle safety concern and is highly dependent on the patient, clinical procedure, and imaging system design and operation. This purpose of this presentation is to provide information relevant to testing and optimizing interventional x-ray fluoroscopy systems to support a wide range of clinical imaging tasks.

The various imaging technologies routinely used in a contemporary invasive cardiology laboratory will be introduced. Comprehensive methods to assess quality and clinically relevant skin entrance air-kerma from interventional fluoroscopy systems will be presented. The relevance of image quality metrics will be presented in the context of the various clinical imaging tasks performed. System optimization with respect to patient dose requires a desire to reduce dose while not affecting the clinical utility of the images. This strategy provides the potential for substantial patient dose reduction. Modern x-ray system design and control offer many possibilities for radiation dose reduction. Specific methods to minimize patient radiation dose while not adversely affecting patient care will be presented.

Learning Objectives:
1. Understand the need for and methods used to fully characterize interventional fluoroscopy system performance as it relates to the clinical imaging task.
2. Recognize system technical parameters that can be adjusted to reduce patient radiation dose.
3. Appreciate the potential for active management to reduce patient radiation dose without adversely affecting the clinical utility of the images.

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