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NEMA Standards Publication XR 31-2016: Standard Attributes On X-Ray Equipment for Interventional Procedures

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P Malca

P Malca1*, A Kuhls-Gilcrist2 , M van Alfen3 , M Lendl4 , K Terasaki5 , R Westrich6 , M Hayes7 , (1) GE Healthcare, Buc, France, (2) Toshiba America Medical Systems, Inc, Tustin, CA, (3) Philips Healthcare, Best, the Netherlands, (4) Siemens Healthineers, Forchheim, Germany, (5) Shimadzu Medical Systems USA, Torrance, CA, (6) Ziehm Imaging, Inc., Orlando, FL, (7) Medical Imaging & Technology Alliance , Arlington, VA


SU-I-GPD-P-6 (Sunday, July 30, 2017) 3:00 PM - 6:00 PM Room: Exhibit Hall

Purpose: Identify key fixed-interventional x-ray equipment attributes that contribute to enhancing patient care and managing radiation dose while still enabling delivery of sufficient image quality required by the interventionalist.

Methods: A literature review was performed to investigate common attributes promoted by scientists and/or US professional societies to improve dose management. A list of attributes that were introduced over the course of the past decade and which are now considered state-of-the-art was developed from this review.

Results: The following key features were identified: Dosimetric Indications: Dose displays can increase awareness and enable monitoring of dose in real-time. Added Filters: Insertion of filters into the x-ray beam can reduce the number of low energy photons that generally do not contribute to an image and can be disproportionately absorbed by the patient’s skin. Range of Fluoroscopy Air Kerma Rates: At least three selectable dose rates permit selection of the appropriate dose for a given imaging task. Last-Image-Hold: The most recently acquired image is displayed after termination of irradiation, potentially reducing the need for additional fluoroscopy. Virtual Collimation: A graphical display of the collimator blade position on the LIH while the collimator blades are adjusted, without irradiation. Stored Fluoroscopy: The capability to store at least 300 frames of the most recent fluoroscopic-imaging sequence, allowing for replay and review during the procedure. Variable Pulsed Fluoroscopy: At least three selectable pulse rates permit selection of the appropriate dose rate for a given imaging task. Digital X-ray Imaging Device: Provides improved dose efficiency versus image intensifier systems across most dose ranges used in radiography and fluoroscopy and enables sophisticated image processing.

Conclusion: NEMA XR31-2016 is designed to assist healthcare facilities in identifying whether their systems include dose management features frequently promoted by US professional societies and can be considered when performing risk management evaluations of existing equipment.

Funding Support, Disclosures, and Conflict of Interest: The authors are representatives of/to the Medical Imaging and Technology Alliance (MITA) and were actively involved in the creation of NEMA XR 31-2016.

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