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Clinical Impact Study of a New High Resolution Fluoroscopic Imager: Analysis of 400,000 Irradiation Events

A Kuhls-Gilcrist*, M Hohn, N Xenos, D Marek, Y Hoi, Canon Medical Systems USA, Tustin, CA


(Sunday, 7/12/2020)   [Eastern Time (GMT-4)]

Room: AAPM ePoster Library

Purpose: To quantify clinical impacts of a next generation fluoroscopic imager with 76 micron pixel high-definition (hi-def) imaging modes using DICOM Radiation Dose Structured Report (RDSR) data from over 400k irradiation events (IEs).

Methods: A DICOM destination was configured to receive RDSRs from multiple interventional fluoroscopy systems performing complex procedures. Study and IE data was extracted and staged in a relational database. Aggregated and non-aggregated data was exported to an Excel compatible format for further analysis that included comparison of procedural results pre/post implementation. During the investigation, system technique factors utilized when in hi-def modes were monitored using IE data to support protocol adjustments towards optimization of overall study-level performance.

Results: Both mean procedure time and number of IEs per case significantly reduced from 43 to 39 minutes and 85 to 78 instances, respectively, indicating improved visualization provided by hi-def modes had a positive impact in increasing procedural efficiencies. During the study, adjustments to hi-def protocols included modifications to pulse width, beam filter, focal spot and dose rate settings to maximize physician satisfaction while also monitoring procedural results, ensuring improvements realized were also observed at the study-level. In general there was a preference across operators towards settings that provided higher image quality and instantaneous dose rates. With an ability to more readily visualize anatomy and device detail that was otherwise difficult/impossible to resolve, less IEs were required resulting in a decrease in overall mean cumulative air kerma.

Conclusion: This work demonstrates a systematic way of leveraging RDSRs to optimize system parameters and the potential clinical impact of substantially increased limiting spatial resolution of 6.6lp/mm. Moving beyond physics level testing into monitoring and analysis of clinical data and performance ensured this new hi-def technology produced clinically meaningful quality and that its benefits were maximized within the framework of actual clinical utilization.

Funding Support, Disclosures, and Conflict of Interest: Authors are employees of Canon Medical Systems USA, Inc.


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