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Feasibility of optimized ultralow-dose pulsed fluoroscopy for upper gastrointestinal tract examinations: a phantom study with clinical correlation

  • ABDOMINAL RADIOLOGY
  • Published:
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Abstract

Purpose

To establish an optimized ultralow-dose digital pulsed fluoroscopy (FP) protocol for upper gastrointestinal tract examinations and to investigate the radiation dose and image quality.

Materials and methods

An Alderson-Rando-Phantom with 60 thermoluminescent dosimeters was used for dose measurements to systematically evaluate the dose–area product (DAP) and organ doses of the optimized FP protocol with the following acquisition parameters: 86.7 kV; 77 mA; 0.9 mm3, automatic image noise and contrast adaption. Subjective image quality, depiction of contrast agent and image noise (5-point Likert scale; 5 = excellent) were assessed in 41 patients, who underwent contrast-enhanced FP with the aforementioned optimized protocol by two radiologists in consensus. A conventional digital radiograph (DR) acquisition protocol served as the reference standard for radiation dose and image quality analyses.

Results

Phantom measurements revealed a general dose reduction of approximately 96% per image for the FP protocol as compared to the DR standard. DAP could be reduced by 97%. Significant dose reductions were also found for organ doses, both in the direct and scattered radiation beam with negligible orbital (FP 5.6 × 10−3 vs. DR 0.11; p = 0.02) and gonadal dose exposure (female FP 2.4 × 10−3 vs. DR 0.05; male FP 8 × 10−4 vs. DR 0.03; p ≤ 0.0004). FP provided diagnostic image quality in all patients, although reading scores were significantly lower for all evaluated parameters as compared to the DR standard (p < 0.05).

Conclusion

Ultralow-dose FP is feasible for clinical routine allowing a significant reduction of direct and scattered dose exposure while providing sufficient diagnostic image quality for reliable diagnosis.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, University of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany

    Jakob Weiss & Mike Notohamiprodjo

  2. Department of Diagnostic and Interventional Radiology, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany

    Jakob Weiss, Andreas Pomschar, Carsten Rist, Wilhelm Flatz, Kolja Thierfelder & Mike Notohamiprodjo

  3. Department of Radiooncology and Radiotherapy, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany

    Klement Neumaier & Minglun Li

Authors
  1. Jakob Weiss
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  2. Andreas Pomschar
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  3. Carsten Rist
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Correspondence to Jakob Weiss.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Local IRB approved this study and waived written informed consent.

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This study received no funding.

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Weiss, J., Pomschar, A., Rist, C. et al. Feasibility of optimized ultralow-dose pulsed fluoroscopy for upper gastrointestinal tract examinations: a phantom study with clinical correlation. Radiol med 122, 822–828 (2017). https://doi.org/10.1007/s11547-017-0793-z

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  • DOI: https://doi.org/10.1007/s11547-017-0793-z

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