title: Feasibility of low-dose digital pulsed video-fluoroscopic swallow exams (VFSE): effects on radiation dose and image quality.
abstract: Background Fluoroscopy is a frequently used examination in clinical routine without appropriate research evaluation latest hardware and software equipment. Purpose To evaluate the feasibility of low-dose pulsed video-fluoroscopic swallowing exams (pVFSE) to reduce dose exposure in patients with swallowing disorders compared to high-resolution radiograph examinations (hrVFSE) serving as standard of reference. Material and Methods A phantom study (Alderson-Rando Phantom, 60 thermoluminescent dosimeters [TLD]) was performed for dose measurements. Acquisition parameters were as follows: (i) pVFSE: 76.7 kV, 57 mA, 0.9 Cu mm, pulse rate/s 30; (ii) hrVFSE: 68.0 kV, 362 mA, 0.2 Cu mm, pictures 30/s. The dose area product (DAP) indicated by the detector system and the radiation dose derived from the TLD measurements were analyzed. In a patient study, image quality was assessed qualitatively (5-point Likert scale, 5 = hrVFSE; two independent readers) and quantitatively (SNR) in 35 patients who subsequently underwent contrast-enhanced pVFSE and hrVFSE. Results Phantom measurements showed a dose reduction per picture of factor 25 for pVFSE versus hrVFSE images (0.0025 mGy versus 0.062 mGy). The DAP (µGym2) was 28.0 versus 810.5 (pVFSE versus hrVFSE) for an average examination time of 30 s. Direct and scattered organ doses were significantly lower for pVFSE as compared to hrVFSE ( P < 0.05). Image quality was rated 3.9 ± 0.5 for pVFSE versus the hrVFSE standard; depiction of the contrast agent 4.8 ± 0.3; noise 3.6 ± 0.5 ( P < 0.05); SNR calculations revealed a relative decreased of 43.9% for pVFSE as compared to hrVFSE. Conclusion Pulsed VFSE is feasible, providing diagnostic image quality at a significant dose reduction as compared to hrVFSE.
authors.affiliation: 1 Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, Tuebingen, Germany.|2 Department of Diagnostic and Interventional Radiology, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Jakob
authors.initials: J
authors.lastname: Weiss
authors.affiliation: 1 Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, Tuebingen, Germany.|2 Department of Diagnostic and Interventional Radiology, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Mike
authors.initials: M
authors.lastname: Notohamiprodjo
authors.affiliation: 3 Department of Radiooncology and Radiotherapy, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Klement
authors.initials: K
authors.lastname: Neumaier
authors.affiliation: 3 Department of Radiooncology and Radiotherapy, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Minglun
authors.initials: M
authors.lastname: Li
authors.affiliation: 2 Department of Diagnostic and Interventional Radiology, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Flatz
authors.affiliation: 1 Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, Tuebingen, Germany.|2 Department of Diagnostic and Interventional Radiology, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Konstantin
authors.initials: K
authors.lastname: Nikolaou
authors.affiliation: 2 Department of Diagnostic and Interventional Radiology, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Pomschar
mesh_terms: D003287:Contrast Media; D003680:Deglutition Disorders / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005240:Feasibility Studies; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D013819:Thermoluminescent Dosimetry; D014741:Video Recording
chemical_list: D003287:Contrast Media
keywords: Head/neck; eating disorders; fluoroscopy; radiation effects; technology assessments