title: A Phantom Study and a Retrospective Clinical Analysis to Investigate the Impact of a New Image Processing Technology on Radiation Dose and Image Quality during Hepatic Embolization.
abstract: OBJECTIVE
  To investigate changes in radiation dose and image quality using phantoms and hepatic embolization procedures performed with a new image processing technology (ClarityIQ) for a single-plane flat-detector-based interventional fluoroscopy system.
  
  
  METHODS
  Phantom study was performed using acrylic sheets simulating different patient sizes. Air kerma rates (AKRs) were compared for different fluoroscopy modes and magnification modes without and with ClarityIQ. Repeat hepatic embolization procedures performed on the same lobe of the liver in the same patient by the same interventional radiologist between January 2013 and July 2014 without and with ClarityIQ were evaluated retrospectively. This included treatment of 33 hepatic lobes in 26 patients. Cumulative air kerma (CAK), kerma-area product (KAP), and factors affecting radiation dose were extracted from study metadata and compared. Blinded randomized image quality review was performed on arteriograms using a five-point scale.
  
  
  RESULTS
  The phantom study revealed a significantly lower AKR (P < .005) with ClarityIQ. Repeated-measures analysis revealed a significant effect of ClarityIQ (P ≤ .001) on CAK and KAP, with reductions ranging between 9% and 85% (median, 67%) and between 5% and 89% (median, 75%), respectively, on a case-by-case basis. Mean reductions in CAK and KAP were 279 mGy and 134,030 mGy·cm(2), respectively. Image quality review scores were significantly lower (P ≤ .001) with ClarityIQ, effecting visualization of tumor vasculature and appearance of noise texture.
  
  
  CONCLUSIONS
  ClarityIQ resulted in radiation dose reduction in the phantom study and in the hepatic embolization procedures, but with a decrease in subjective perceptions of image quality.
authors.affiliation: Department of Radiology, Thomas Jefferson University, Main Building, 132 S. 10th St., Suite 1092B, Philadelphia, PA, 19107, Lancaster, Pennsylvania. Electronic address: jaydev.dave@jefferson.edu.
authors.forename: Jaydev K
authors.initials: JK
authors.lastname: Dave
authors.affiliation: Department of Radiology, Thomas Jefferson University, Main Building, 132 S. 10th St., Suite 1092B, Philadelphia, PA, 19107, Lancaster, Pennsylvania.
authors.forename: David J
authors.initials: DJ
authors.lastname: Eschelman
authors.affiliation: Franklin and Marshall College, Lancaster, Pennsylvania.
authors.forename: Jenna R
authors.initials: JR
authors.lastname: Wasserman
authors.affiliation: Department of Radiology, Thomas Jefferson University, Main Building, 132 S. 10th St., Suite 1092B, Philadelphia, PA, 19107, Lancaster, Pennsylvania.
authors.forename: Carin F
authors.initials: CF
authors.lastname: Gonsalves
authors.affiliation: Department of Radiology, Thomas Jefferson University, Main Building, 132 S. 10th St., Suite 1092B, Philadelphia, PA, 19107, Lancaster, Pennsylvania.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Gingold
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000628:therapy*; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging / Q000556:secondary / Q000628:therapy*; D008875:Middle Aged; D019047:Phantoms, Imaging; D011237:Predictive Value of Tests; D011829:Radiation Dosage; D000069079:Radiation Exposure; D011857:Radiographic Image Interpretation, Computer-Assisted; D015641:Radiography, Interventional / Q000295:instrumentation* / Q000379:methods*; D012189:Retrospective Studies; D012984:Software; D016896:Treatment Outcome; D014604:Uveal Neoplasms / Q000473:pathology*; D000098943:Uveal Melanoma