The Society of Cardiovascular Angiography and Interventions present a practical approach to assist cardiac catheterization laboratories in establishing a radiation safety program. The importance of this program is emphasized by the appropriate concerns for the increasing use of ionizing radiation in medical imaging, and its potential adverse effects. An overview of the assessment of radiation dose is provided with a review of basic terminology for dose management. The components of a radiation safety program include essential personnel, radiation monitoring, protective shielding, imaging equipment, and training/education. A procedure based review of radiation dose management is described including pre-procedure, procedure and post-procedure best practice recommendations. Specific radiation safety considerations are discussed including women and fluoroscopic procedures as well as patients with congenital and structural heart disease.

Radiographic imaging of large patients is compromised by x-ray scatter. Optimization of digital x-ray imaging systems used for projection radiography requires the use of the best possible antiscatter grid. The performance of antiscatter grids used in conjunction with digital x-ray imaging systems can be characterized through measurement of the signal-to-noise ratio (SNR) improvement factor (K(SNR)). The SNR improvement factor of several linear, focused antiscatter grids was determined from measurements of the fundamental primary and scatter transmission fraction measurements of the grids as well as the inherent scatter-to-primary ratio (SPR) of the x-ray beam and scatter phantom. The inherent SPR and scatter transmission fraction was measured using a graduated lead beam stop method. The K(SNR) of eight grids with line rates (N) in the range 40 to 80 cm(-1) and ratios (r) in the range 8:1 to 15:1 was measured. All of the grids had fiber interspace material and carbon-fiber covers. The scatter phantom used was Solid Water(R) with thickness 10 to 50 cm, and a 30 x 30 cm(2) field of view was used. All measurements were acquired using a 104 kVp x-ray beam. The SPR of the non-grid imaging condition ranged from 2.55 for the 10 cm phantom to 25.9 for the 50 cm phantom. The scatter transmission fractions ranged from a low of 0.083 for the N50 r15 grid to a high of 0.22 for the N40 r8 grid and the primary transmission fractions ranged from a low of 0.69 for the N80 r15 grid to 0.76 for the N40 r8 grid. The SNR improvement factors ranged from 1.2 for the 10 cm phantom and N40 r8 grid to 2.09 for the 50 cm phantom and the best performing N50 r15, N44 r15 and N40 r14 grids.

Radiation shields can provide substantial protection from radiation during cardiac interventional procedures. Shields must be thoughtfully and actively managed to provide optimum protection. Best practice guidelines for shield use are provided.

Several primary determinants of patient radiation dose during PCI were identified. Along with physician development of radiation-sparing methods and skills, pre-procedure dose planning is proposed to help minimize radiation dose for PCI.

Channelized Hotelling model observer (CHO) methods were developed to assess performance of an x-ray angiography system. The analytical methods included correction for known bias error due to finite sampling. Detectability indices ([Formula: see text]) corresponding to disk-shaped objects with diameters in the range 0.5-4 mm were calculated. Application of the CHO for variable detector target dose (DTD) in the range 6-240 nGy frame(-1) resulted in [Formula: see text] estimates which were as much as 2.9×  greater than expected of a quantum limited system. Over-estimation of [Formula: see text] was presumed to be a result of bias error due to temporally variable non-stationary noise. Statistical theory which allows for independent contributions of 'signal' from a test object (o) and temporally variable non-stationary noise (ns) was developed. The theory demonstrates that the biased [Formula: see text] is the sum of the detectability indices associated with the test object [Formula: see text] and non-stationary noise ([Formula: see text]). Given the nature of the imaging system and the experimental methods, [Formula: see text] cannot be directly determined independent of [Formula: see text]. However, methods to estimate [Formula: see text] independent of [Formula: see text] were developed. In accordance with the theory, [Formula: see text] was subtracted from experimental estimates of [Formula: see text], providing an unbiased estimate of [Formula: see text]. Estimates of [Formula: see text] exhibited trends consistent with expectations of an angiography system that is quantum limited for high DTD and compromised by detector electronic readout noise for low DTD conditions. Results suggest that these methods provide [Formula: see text] estimates which are accurate and precise for [Formula: see text]. Further, results demonstrated that the source of bias was detector electronic readout noise. In summary, this work presents theory and methods to test for the presence of bias in Hotelling model observers due to temporally variable non-stationary noise and correct this bias when the temporally variable non-stationary noise is independent and additive with respect to the test object signal.

Abstract. Evaluation of flat-panel angiography equipment through conventional image quality metrics is limited by the scope of standard spatial-domain image quality metric(s), such as contrast-to-noise ratio and spatial resolution, or by restricted access to appropriate data to calculate Fourier domain measurements, such as modulation transfer function, noise power spectrum, and detective quantum efficiency. Observer models have been shown capable of overcoming these limitations and are able to comprehensively evaluate medical-imaging systems. We present a spatial domain-based channelized Hotelling observer model to calculate the detectability index (DI) of our different sized disks and compare the performance of different imaging conditions and angiography systems. When appropriate, changes in DIs were compared to expectations based on the classical Rose model of signal detection to assess linearity of the model with quantum signal-to-noise ratio (SNR) theory. For these experiments, the estimated uncertainty of the DIs was less than 3%, allowing for precise comparison of imaging systems or conditions. For most experimental variables, DI changes were linear with expectations based on quantum SNR theory. DIs calculated for the smallest objects demonstrated nonlinearity with quantum SNR theory due to system blur. Two angiography systems with different detector element sizes were shown to perform similarly across the majority of the detection tasks.

ABBREVIATIONS CIED = cardiovascular implantable electronic device; CT = computed tomography; EP = electrophysiology; FDA = U.S. Food and Drug Administration; ICD=implantable cardioverterdefibrillator; MRI = magnetic resonance imaging; QA = quality assurance; QI = quality improvement; RF = radiofrequency; VT = ventricular tachycardia (Heart Rhythm 2014;11:e9-e51) Developed in collaboration with and endorsed

The image quality of a dedicated mammography computed radiography (CR) system was characterized. A unique feature of this system is that it collects image signals from both sides of the storage phosphor. Measurements of the modulation transfer function (MTF), noise power spectrum (NPS), and detective quantum efficiency (DQE) were made. This work included improvements in our measurement methods to specifically account for the detrimental effects of system glare on the MTF and to accurately characterize the low-frequency NPS components. Image quality measurements were performed using a 25 kVp beam filtered with 2 mm Al and an exposure range of 1 to 100 mR (87 to 870 microGy). The DQE was found to decrease with increasing exposure due to an increased contribution of storage phosphor structure noise. The DQE of this system was compared to similar measurements made using a standard CR system. The dual-side read system demonstrated superior DQE compared to the standard system. The decrease in DQE with increasing exposure was more severe for the standard system than the dual-side read system. This finding suggests that the CR system noise was reduced for the dual-side read system compared to the standard system.