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The purpose of this study was to evaluate the effect of placing small lead shields on the temple region of the skull to reduce radiation dose to the lens of the eye during interventional fluoroscopically-guided procedures and cone-beam computed tomography (CBCT) scans of the head. EGSnrc Monte-Carlo code was used to determine the eye lens dose reduction when using lateral lead shields for single x-ray projections, CBCT scans with different protocols, and interventional neuroradiology procedures with the Zubal computational head phantom. A clinical C-Arm system was used to take radiographic projections and CBCT scans of anthropomorphic head phantoms without and with lead patches, and the images were compared to assess the effect of the shields. For single lateral projections, a 0.1 (0.3)-mm-thick lead patch reduced the dose to the left-eye lens by 40% to 60% (55% to 80%) from 45° to 90° RAO and to the right-eye lens by around 30% (55%) from 70° to 90° RAO. For different CBCT protocols, the reduction of lens dose with a 0.3-mm-thick lead patch ranged from 20% to 53% at 110 kVp. For CBCT scans of the anthropomorphic phantom, the lead patch introduced streak artifacts that were mainly in the orbital regions but were insignificant in the brain region where most neurointerventional activity occurs. The dose to the patient's eye lens can be reduced considerably by placing small lead shields over the temple region of the head without substantially compromising image quality in neuro-imaging procedures.

Purpose: The performance of a newly developed, high resolution, microangiographic fluoroscope (MAF) (35 μm pixel pitch and 300 μm thick CsI phosphor) was evaluated using a generalized linear system analysis and compared with that of a standard amorphous Si thin film transistor flat panel detector (FPD) (194 μm pixel pitch and 600 μm thick CsI phosphor). The linear system metrics such as modulation transfer function (MTF), noise power spectrum, and detection quantum efficiency (DQE) are commonly used to gauge the intrinsic detector performance in the detector plane. However, these linear system metrics do not provide information about the image receptor performance in a real system since they do not include the effects of other parameters such as focal spot distribution, scatter radiation, and geometric unsharpness, which may compromise detector performance characteristics. Use of generalized linear system metrics [generalized modulation transfer function (GMTF), generalized normalized noise power spectrum (GNNPS), and generalized detection quantum efficiency (GDQE)] that include these effects gives a more meaningful, complete, and appropriate evaluation of detector performance as part of the imaging system., Methods: A uniform head equivalent phantom was used to simulate realistic clinical parameters and x-ray spectra. The detector MTFs were measured using the slanted edge method and the focal spot MTFs were measured using a pinhole assembly. The scatter MTF was simulated and the scatter fraction was measured for a head-equivalent phantom. The generalized system metrics were calculated for different combinations of three choices of focal spots and three different magnifications with two different air-gaps. The performance of the MAF was also illustrated using stent images obtained with different focal spots under similar conditions., Results: Results for the generalized metrics provide a quantitative description of the performance of the imaging system for both detectors. This generalized analysis demonstrated that both detectors have similar imaging capabilities at lower spatial frequencies, but that the MAF has superior performance over the FPD at higher frequencies even when considering focal spot blurring and scatter., Conclusions: This generalized performance analysis demonstrates the significance of focal spot size, magnification, and scatter on the system performance metrics (GMTF, GNNPS, and GDQE). Although the ideal detector performance characteristics of the MAF are not fully realized due to these other system factors, it still retains an advantage in DQE at high spatial frequencies over the FPD. Similar studies based on the generalized linear system metrics can serve as an efficient tool to evaluate total system capabilities under different realistic conditions to enable optimal design for specific imaging tasks.

Background: Neurointervention is an ever-evolving specialty with tools including microcatheters, microwires, and coils that allow treatment of pathological conditions in increasingly smaller intracranial arteries, requiring increasing accuracy. As endovascular tools evolve, so too should the imaging., Objective: To detail the use of microangiography performed with a novel fluoroscope during coiling of intracranial aneurysms in 2 separate patients and discuss the benefits and potential limitations of the technology., Methods: The microangiographic fluoroscope (MAF) is an ultra high-resolution x-ray detector with superior resolution over a small field of view. The MAF can be incorporated into a standard angiographic C-arm system for use during endovascular procedures., Results: The MAF was useful for improved visualization during endovascular coiling of 2 unruptured intracranial aneurysms, without adding significant time to the procedure. No significant residual aneurysm filling was identified post-coiling, and no complications occurred., Conclusion: The MAF is a high-resolution detector developed for use in neurointerventional cases in which superior image quality over a small field of view is required. It has been used with success for coiling of 2 unruptured aneurysms at our institution. It shows promise as an important tool in improving the accuracy with which neurointerventionists can perform certain intracranial procedures.

Currently, a large number of endovascular interventions are performed for treatment of intracranial aneurysms. For these treatments, correct positioning of microcatheter tips, microguide wire tips, or coils is essential. Techniques to detect such devices may facilitate endovascular interventions. In this paper, we describe an algorithm for tracking of microcatheter tips during fluoroscopically guided neuroendovascular interventions. A sequence of fluoroscopic images (1,024 x 1,024 x 12 bits) was acquired using a C-arm angiography system as a microcatheter was passed through a carotid phantom which was on top of a head phantom. The carotid phantom was a silicone cylinder containing a simulated vessel with the shape and curvatures of the internal carotid artery. The head phantom consisted of a human skull and tissue-equivalent material. To detect the microcatheter in a given fluoroscopic frame, a background image consisting of an average of the four previous frames is subtracted from the current frame, the resulting image is filtered using a matched filter, and the position of maximum intensity in the filtered image is taken as the catheter tip position in the current frame. The distance between the tracked position and the correct position (error distance) was measured in each of the fluoroscopic images. The mean and standard deviation of the error distance values were 0.277 mm (1.59 pixels) and 0.26 mm (1.5 pixels), respectively. The error distance was less than 3 pixels in the 93.0% frames. Although the algorithm intermittently failed to correctly detect the catheter, the algorithm recovered the catheter in subsequent frames.

We compared three techniques for enhancement of microcatheter tips in fluoroscopic images: conventional subtraction technique (CST); averaged image subtraction technique (AIST), which we have developed; and double average filtering (DAF) technique, which uses nonlinear background estimates. A pulsed fluoroscopic image sequence was obtained as a microcatheter was passed through a carotid phantom that was on top of a head phantom. The carotid phantom was a silicone cylinder containing a simulated vessel with the shape and curvatures of the internal carotid artery. The three techniques were applied to the images of the sequence, then the catheter tip was manually identified in each image, and 100 x 100 pixel images, centered at the indicated microcatheter tip positions, were extracted for the evaluations. The signal-to-noise ratio (SNR) was calculated in each of the extracted images from which the mean value of the SNR and its standard deviation (SD) were calculated for each technique. The mean values and the standard deviations were 4.36 (SD 3.40) for CST, 6.34 (SD 3.62) for AIST, and 3.55 (SD 1.27) for DAF. AIST had a higher SNR compared to CST in almost all frames. Although DAF yielded the smallest mean SNR value, it yielded the best SNR in those frames in which the microcatheter tip did not move between frames. We conclude that AIST provides the best SNR for a moving microcatheter tip and that DAF is optimal for a temporarily stationary microcatheter tip.