Skip to main content
banner image
No data available.
Please log in to see this content.
You have no subscription access to this content.
No metrics data to plot.
The attempt to load metrics for this article has failed.
The attempt to plot a graph for these metrics has failed.
The full text of this article is not currently available.
1. National Council on Radiation Protection and Measurements, Radiation Dose Management for Fluoroscopically-Guided Interventional Medical Procedures, NCRP Report 168 (NCRP, Bethesda, MD, 2011).
2. P. J. Lin, “The operation logic of automatic dose control of fluoroscopy system in conjunction with spectral shaping filters,” Med. Phys. 34, 31693172 (2007).
3. International Electrotechnical Commission, Medical Electrical Equipment - Part 2-43: Particular Requirements for the Safety of X-ray Equipment for Interventional Procedures (International Electrotechnical Commission, Geneva, 2000).
4. F. Gebhard, C. Riepl, P. Richter, A. Liebold, H. Gorki, R. Wirtz, R. König, F. Wilde, A. Schramm, and M. Kraus, “The hybrid operating room. Home of high-end intraoperative imaging,” Unfallchirurg 115, 107120 (2012).
5. A. Norbash, L. W. Klein, J. Goldstein, D. Haines, S. Balter, L. Fairobent, D. L. Miller, and Multispecialty Occupational Health Group, “The neurointerventional procedure room of the future: Predicting likely innovations in design and function,” J. Neurointerv. Surg. 3, 266271 (2011).
6. A. Durán, S. K. Hilan, D. L. Miller, J. Le Hereon, R. Padovani, and E. Vano, “A summary of recommendations for occupational radiation protection in interventional cardiology,” Cathet. Cardiovasc. Interv. 81, 562567 (2013).
7. K. Chida, Y. Kaga, Y. Haga, N. Kataoka, E. Kumasaka, T. Meguro, and M. Zuguchi, “Occupational dose in interventional radiology procedures,” Am. J. Roentgenol. 200, 138141 (2013).
8. European Commission, RP-162 Criteria for Acceptability of Radiological, Nuclear Medicine and Radiotherapy Equipment (European Commission, Luxembourg, 2012).
9. National Electrical Manufacturer's Association, XR 27-2013: X-ray Equipment for Interventional Procedures, User Quality Control Mode (NEMA, Rosslyn, VA, 2012).
10. American Association of Physicists in Medicine, AAPM Report 4: Basic Quality Control in Diagnostic Radiology (AAPM, New York, NY, 1977).
11. American Association of Physicists in Medicine, AAPM Report 15: Performance Evaluation and Quality Assurance in Digital Subtraction Angiography (American Institute of Physics, New York, NY, 1985).
12. American Association of Physicists in Medicine, AAPM Report 31: Standardized Methods for Measuring Diagnostic X-ray Exposures (American Institute of Physics, New York, NY, 1990).
13. American Association of Physicists in Medicine, AAPM Report 60: Instrumentation Requirements of Diagnostic Radiological Physicists (Generic Listing) (Medical Physics Publishing, Madison, WI, 1998).
14. American Association of Physicists in Medicine, AAPM Report 70: Cardiac Catheterization Equipment Performance (Medical Physics Publishing, Madison, WI, 2001).
15. American Association of Physicists in Medicine, AAPM Report 74: Quality Control in Diagnostic Radiology (Medical Physics Publishing, Madison, WI, 2002).
16. A. R. Cowen, S. M. Kengyelics, and A. G. Davies, “REVIEW-Solid-state, flat-panel, digital radiography detectors and their physical imaging characteristics,” Clin. Radiol. 63, 487498 (2008).
17. A. R. Cowen, A. G. Davies, and M. U. Sivananthan, “The design and imaging characteristics of dynamic, solid-state, flat-panel x-ray image detectors for digital fluoroscopy and fluorography,” Clin. Radiol. 63, 10731085 (2008).
18. A. Koch, H.-M. Macherel, T. Wirth, P. M. de Groot, T. Ducourant, D. Couder, J.-P. Moy, and E. Calais, “Detective quantum efficiency of an x-ray image intensifier chain as a benchmark or amorphous silicon flat panel detectors,” Proc. SPIE 4320, 115 (2001).
19. P. Rauch et al., “Functionality and operation of fluoroscopic automatic brightness control/automatic dose rate control logic in modern cardiovascular and interventional angiography systems: A Report of Task Group 125 Radiography/Fluoroscopy Subcommittee, Imaging Physics Committee, Science Council,” Med. Phys. 39, 28262828 (2012).
20. American Association of Physicists in Medicine, AAPM Report 125: Functionality and Operation of Fluoroscopic Automatic Brightness Control/Automatic Dose Rate Control Logic in Modern Cardiovascular and Interventional Angiography Systems (AAPM, College Park, MD, 2012).
21. P. Rauch, “SU-GG-I-96: The “30-30-30 Rule,” a practical guide to setting the detector input exposure rate for a fluoroscopic imager,” Med. Phys. 37, 3123 (2010).
22. K. J. Strauss, “Pediatric interventional radiography equipment: Safety considerations,” Pediatr. Radiol. 36(Suppl 2), 126135 (2006).
23. F. Schaeffel, “Processing of information in the human visual system,” in Handbook of Machine Vision, edited by A. Hornberg (Wiley-VCH, Weinheim, 2006), pp. 134.
24. R. Aufrichtig, P. Xue, C. W. Thomas, G. C. Gilmore, and D. L. Wilson, “Perceptual comparison of pulsed and continuous fluoroscopy,” Med. Phys. 21, 245256 (1994).
25. R. Schumacher and H. Allmendinger, “Optimization of pulsed fluoroscopy in pediatric radiology using voiding cystourethrography as an example,” Med. Mundi 52, 1824 (2008).
26. B. Belanger and J. Boudry, “Management of pediatric radiation dose using GE fluoroscopic equipment,” Pediatr. Radiol. 36(Suppl 2), 204211 (2006).
27. National Electrical Manufacturer's Association, Digital Imaging and Communications in Medicine (DICOM) Part 3: Information Object Definitions (PS 3.3-2012) (NEMA, Rosslyn, VA, 2009), see, accessed April 2013.
28. National Electrical Manufacturer's Association, Digital Imaging and Communications in Medicine (DICOM) Supplement 94: Diagnostic X-Ray Radiation Dose Reporting (Dose SR) (NEMA, Rosslyn, VA, 2005), see, accessed April 2013.
29. A. K. Jones and A. S. Pasciak, “Calculating the peak skin dose resulting from fluoroscopically-guided interventions. Part I: Methods,” J. Appl. Clin. Med. Phys. 12, 231244 (2011).
30. A. K. Jones and A. S. Pasciak, “Calculating the peak skin dose resulting from fluoroscopically-guided interventions. Part II: Case studies,” J. Appl. Clin. Med. Phys. 13, 174186 (2012).
31. W. R. Geiser, W. Huda, and N. A. Gkanatsios, “Effect of patient support pads on image quality and dose in fluoroscopy,” Med. Phys. 24, 377382 (1997).
32. N. Petoussi-Henss, M. Zankl, G. Drexler, W. Panzer, and D. Regulla, “Calculation of backscatter factors for diagnostic radiology using Monte Carlo methods,” Phys. Med. Biol. 43, 22372250 (1998).
33. A. S. Pasciak and A. K. Jones, “Does “spreading” skin dose by rotating the C-arm during an intervention work?,” J. Vasc. Interv. Radiol. 22, 443452 (2011), quiz 53.
34. A. S. Pasciak and A. K. Jones, “SU-E-I-24: How does C-arm rotation affect peak skin dose in interventional cardiology?,” Med. Phys. 40, 130 (2013).
35. L. K. Wagner and B. R. Archer, Minimizing Risks from Fluoroscopic X-rays: A Credentialing Program for Anesthesiologists, Cardiologists, Gastroenterologists, Interventionalists, Orthopedists, Physiatrists, Pulmonologists, Radiologists, Surgeons, and Urologists and Radiographers, 4th ed. (Partners in Radiation Management, LTD, The Woodlands, TX, 2004).
36. M. S. Stecker et al., “Guidelines for patient radiation dose management,” J. Vasc. Interv. Radiol. 20, S263S273 (2009).
37. S. Balter, J. W. Hopewell, D. L. Miller, L. K. Wagner, and M. J. Zelefsky, “Fluoroscopically guided interventional procedures: A review of radiation effects on patients’ skin and hair,” Radiology 254, 326341 (2010).
38. The Joint Commission, Radiation Overdose as a Reviewable Sentinel Event (available URL: Accessed April 2013.
39. I. MacKenzie, “Breast cancer following multiple fluoroscopies,” Br. J. Cancer 19, 18 (1965).
40. T. R. Koenig, D. Wolff, F. A. Mettler, and L. K. Wagner, “Skin injuries from fluoroscopically guided procedures: Part 1, Characteristics of radiation injury,” Am. J. Roentgenol. 177, 311 (2001).
41. T. R. Koenig, F. A. Mettler, and L. K. Wagner, “Skin injuries from fluoroscopically guided procedures: Part 2, Review of 73 cases and recommendations for minimizing dose delivered to patient,” Am. J. Roentgenol. 177, 1320 (2001).
42. S. Yoshinaga, K. Mabuchi, A. J. Sigurdson, M. M. Doody, and E. Ron, “Cancer risks among radiologists and radiologic technologists: Review of epidemiologic studies,” Radiology 233, 313321 (2004).
43. E. Vañó, L. Gonzalez, F. Beneytez, and F. Moreno, “Lens injuries induced by occupational exposure in nonoptimized interventional radiology laboratories,” Br. J. Radiol. 71, 728733 (1998).
44. P. Brown, American Martyrs to Science Through the Roentgen Ray (Charles C. Thomas, Springfield, IL, 1936).
45. L. K. Wagner, R. G. Lester, and L. R. Saldana, Exposure of the Pregnant Patient to Diagnostic Radiations: A Guide to Medical Management, 2nd ed. (Medical Physics Publishing, Madison, WI, 1997).
46. Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation, Health Risks from Exposure to Low Levels of Ionizing Radiation. BEIR VII Phase 2 (The National Academies, Washington, D.C., 2006).
47. J. Daniel, ““The X-rays” (Letter),” Science 3, 562563 (1896).
48. K. Sansare, V. Khanna, and F. Karjodkar, “Early victims of x-rays: A tribute and current perception,” Dentomaxillofac Radiol. 40, 123125 (2011).
49.Edison fears the hidden perils of the X-rays,” New York World, August 3, 1903.
50. E. R. N. Grigg, The Trail of the Invisible Light (Charles C. Thomas, Springfield, IL, 1965).
51. O. Hesse, Fortschr. Geb. Rontgenstr. 17, 82 (1911).
52. Committee on the Biological Effects of Ionizing Radiations, Health Effects of Exposure to Low Levels of Ionizing Radiation. BEIR V (The National Academies, Washington, D.C., 1990).
53. J. D. Boice Jr., C. E. Land, R. E. Shore, J. E. Norman, and M. Tokunaga, “Risk of breast cancer following low-dose radiation exposure,” Radiology 131, 589597 (1979).
54.United States of America, Radiation Control for Health and Safety Act, 1968.
55. T. B. Shope, “Radiation-induced skin injuries from fluoroscopy,” Radiographics 16, 11951199 (1996).
56. D. L. Miller, S. Balter, B. A. Schueler, L. K. Wagner, K. J. Strauss, and E. Vano, “Clinical radiation management for fluoroscopically guided interventional procedures,” Radiology 257, 321332 (2010).
57. D. L. Aventin, I. Gil, D. M. L. Gonzalez, and R. M. Pujol, “Chronic scalp ulceration as a late complication of fluoroscopically guided cerebral aneurysm embolization,” Dermatology 224, 198203 (2012).
58. R. Ukisu, T. Kushihashi, and I. Soh, “Skin injuries caused by fluoroscopically guided interventional procedures: Case-based review and self-assessment module,” Am. J. Roentgenol. 193, S59S69 (2009).
59. L. De Olazo Banaag and M. J. Carter, “Radionecrosis induced by cardiac imaging procedures: A case study of a 66-year-old diabetic male with several comorbidities,” J. Invasive Cardiol. 20, E233E236 (2008).
60. E. Vañó, L. Arranz, J. M. Sastre, C. Moro, A. Ledo, M. T. Gárate, and I. Minguez, “Dosimetric and radiation protection considerations based on some cases of patient skin injuries in interventional cardiology,” Br. J. Radiol. 71, 510516 (1998).
61. R. E. Vlietstra, L. K. Wagner, T. Koenig, and F. Mettler, “Radiation burns as a severe complication of fluoroscopically guided cardiological interventions,” J. Interv. Cardiol. 17, 131142 (2004).
62. L. Wong and J. Rehm, “Radiation injury from a fluoroscopic procedure,” N. Engl. J. Med. 350, e23 (2004).
63. B. V. Worgul et al.Cataracts among Chernobyl clean-up workers: Implications regarding permissible eye exposures,” Radiat. Res. 167, 233243 (2007).
64. A. C. Kak and M. Slaney, Principles of Computerized Tomographic Imaging (IEEE, New York, NY, 1988).
65. L. A. Feldkamp, L. C. Davis, and J. W. Kress, “Practical cone-beam algorithm,” J. Opt. Soc. Am. A 1, 612619 (1984).
66. J. H. Siewerdsen, J. W. Stayman, and F. Noo, “Advances in 3D image reconstruction,” in Image Processing in Radiation Therapy edited by K. K. Brock (CRC, Boca Raton, FL, 2013), pp. 171192.
67. Y. Cho, D. J. Moseley, J. H. Siewerdsen, and D. A. Jaffray, “Accurate technique for complete geometric calibration of cone-beam computed tomography systems,” Med. Phys. 32, 968983 (2005).
68. M. J. Daly, J. H. Siewerdsen, Y. B. Cho, D. A. Jaffray, and J. C. Irish, “Geometric calibration of a mobile C-arm for intraoperative cone-beam CT,” Med. Phys. 35, 21242136 (2008).
69. G.-H. Chen, J. Zambelli, B. E. Nett, M. Supanich, C. Riddell, B. Belanger, and C. A. Mistretta, “Design and development of C-arm based cone-beam CT for image-guided interventions: Initial results,” Proc. SPIE 6142, 614210 (2006).
70. J. Geleijns, M. S. Artells, P. W. de Bruin, R. Matter, Y. Muramatsu, and M. F. McNitt-Gray, “Computed tomography dose assessment for a 160 mm wide, 320 detector row, cone beam CT scanner,” Phys. Med. Biol. 54, 31413159 (2009).
71. R. L. Dixon, “A new look at CT dose measurement: Beyond CTDI,” Med. Phys. 30, 12721280 (2003).
72. R. L. Dixon and J. M. Boone, “Cone beam CT dosimetry: A unified and self-consistent approach including all scan modalities – With or without phantom motion,” Med. Phys. 37, 27032718 (2010).
73. R. Fahrig, R. Dixon, T. Payne, R. L. Morin, A. Ganguly, and N. Strobel, “Dose and image quality for a cone-beam C-arm CT system,” Med. Phys. 33, 45414550 (2006).
74. M. J. Daly, J. H. Siewerdsen, D. J. Moseley, D. A. Jaffray, and J. C. Irish, “Intraoperative cone-beam CT for guidance of head and neck surgery: Assessment of dose and image quality using a C-arm prototype,” Med. Phys. 33, 37673780 (2006).
75. S. Schafer, S. Nithananiathan, D. J. Mirota, A. Uneri, J. W. Stayman, W. Zbijewski, C. Schmidgunst, G. Kleinszig, A. J. Khanna, and J. H. Siewerdsen, “Mobile C-arm cone-beam CT for guidance of spine surgery: Image quality, radiation dose, and integration with interventional guidance,” Med. Phys. 38, 45634574 (2011).
76. Y. Kyriakou, P. Deak, O. Langner, and W. A. Kalendar, “Concepts for dose determination in flat-detector CT,” Phys. Med. Biol. 53, 35513566 (2008).
77. American Association of Physicists in Medicine, AAPM Report 111: Comprehensive Methodology for the Evaluation of Radiation Dose in X-ray Computed Tomography (AAPM, College Park, MD, 2010).
78. J. A. Anderson, T. Dallas, D. P. Chason, T. J. Lane, and A. L. McAnulty, “CT dosimetry and the new modalities: Cone-beam and wide area CT,” Presented at the 2004 Meeting of the Radiological Society of North America, Chicago, IL, 2004.
79. J. H. Siewerdsen and D. A. Jaffray, “Cone-beam computed tomography with a flat-panel imager: Effects of image lag,” Med. Phys. 26, 26352647 (1999).
80. J. H. Siewerdsen and G-H. Chen, “Computed tomography II – C-arm cone-beam CT: Principles and applications,” Presented at the 2009 meeting of the American Association of Physicists in Medicine, Anaheim, CA (TU-A-303A) (2009) (available URL: Accessed April 2013.
81. Y. Kyriakou and W. Kalendar, “Efficiency of antiscatter grids for flat-detector CT,” Phys. Med. Biol. 52, 62756293 (2007).
82. J. H. Siewerdsen and D. A. Jaffray, “Cone-beam computed tomography with a flat-panel imager: Magnitude and effects of x-ray scatter,” Med. Phys. 28, 220231 (2001).
83. J. Hsieh, “Compensation of computed tomography data for detector afterglow,” U.S. patent 5249123A (Sept. 28 1993).
84. J. Hsieh, O. E. Gurmen, and K. F. King, “Recursive correction algorithm for detector decay characteristics in CT,” Proc. SPIE 3977, 298 (2000).
85. A. K. Jones and A. Mahvash, “Evaluation of the potential utility of flat panel CT for quantifying relative contrast enhancement,” Med. Phys. 39, 41494154 (2012).
86. J. H. Siewerdsen, “Cone-beam CT with a flat-panel detector: From image science to image-guided surgery,” Nucl. Instrum. Methods Phys. Res. 648, S241S250 (2011).
87. J. H. Siewerdsen, D. J. Moseley, S. Burch, S. Bisland, A. Bogaards, B. A. Wilson, and D. A. Jaffray, “Volume CT with a flat-panel detector on a mobile, isocentric C-arm: Pre-clinical investigation in guidance of minimally invasive surgery,” Med. Phys. 32, 241254 (2005).
88.Estimating the required IAKR for a-Se is slightly more complicated as the absorption characteristics of a-Se differ from CsI owing to the lower atomic number of Se—e.g., a typical fluoroscopic x-ray spectrum will be absorbed less efficiently by a-Se than by CsI for conversion layers of the same thickness. In practice, a-Se conversion layers are often manufactured thicker than CsI conversion layers as lateral spreading of secondary information carriers is limited in a-Se, resulting in similar absorption efficiencies between a-Se and CsI.
89.“Fill frame” as used here has a different meaning than it does for digital subtraction angiography (DSA). During pulsed fluoroscopy, a constant image refresh rate is maintained regardless of the fluoroscopic image rate. Frame-filling is the use of “fill frames,” which contain the same noise impression and no new information, to achieve the desired refresh rate. The integration of multiple fill frames in the HVS does not result in a reduced perception of image noise.

Data & Media loading...


Article metrics loading...



The 2012 Summer School of the American Association of Physicists in Medicine (AAPM) focused on optimization of the use of ionizing radiation in medical imaging. Day 2 of the Summer School was devoted to fluoroscopy and interventional radiology and featured seven lectures. These lectures have been distilled into a single review paper covering equipment specification and siting, equipment acceptance testing and quality control, fluoroscope configuration, radiation effects, dose estimation and measurement, and principles of flat panel computed tomography. This review focuses on modern fluoroscopic equipment and is comprised in large part of information not found in textbooks on the subject. While this review does discuss technical aspects of modern fluoroscopic equipment, it focuses mainly on the clinical use and support of such equipment, from initial installation through estimation of patient dose and management of radiation effects. This review will be of interest to those learning about fluoroscopy, to those wishing to update their knowledge of modern fluoroscopic equipment, to those wishing to deepen their knowledge of particular topics, such as flat panel computed tomography, and to those who support fluoroscopic equipment in the clinic.


Full text loading...


Access Key

  • FFree Content
  • OAOpen Access Content
  • SSubscribed Content
  • TFree Trial Content
752b84549af89a08dbdd7fdb8b9568b5 journal.articlezxybnytfddd