Purpose: To compare the visualization of neurointervention procedure and treatment devices using a 194 µm pixel Flat Panel Detector mode (FPD) and a 76 µm pixel Complementary Metal Oxide Semiconductor detector mode (HiDef ) of a new generation x-ray detector system using a blinded rater study. Materials and Methods: Deployment of flow diversion devices for the treatment of internal carotid artery aneurysms was performed under FPD and HiDef mode image guidance in a neurointervention phantom simulating patient cranium and tissue attenuation, embedded with 3D printed intracranial vascular models, each with an aneurysm in the ICA segment. Image sequence pairs of device deployments for each detector mode, under similar exposure and FOV conditions were evaluated by two blinded experienced neurointerventionists who independently selected their preferred image based on visualization of anatomical features, image noise and treatment device. They rated their selection as either similar; better; much better; substantially better than the other. Inter and Intra rater agreements were calculated and categorized as poor, moderate and good. Results: Both the raters demonstrating good inter and intra rater agreements, selected HiDef mode images with a frequency of at least 95% each and on an average rated the HiDef images as much better than FPD images with a frequency of 73% from a total of 60 image pairs. Conclusion: Due to their higher resolution, HiDef mode images are sharper and visually preferred compared to the FPD images. The improved imaging provided by the HiDef mode can potentially provide an advantage during neurointervention procedures.
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