Related Experiment Video
Updated: Oct 16, 2025
X-ray Dose Reduction through Adaptive Exposure in Fluoroscopic Imaging
Published on: September 11, 2011
Harmonisation of imaging protocols, radiation doses and image quality in gastrointestinal fluoroscopy examinations -
Aurélie Forbes1, Bouchra Habib Geryes2, Amaury Hornbeck3,4,5
1Radiology Department, Public Assistance - Paris Hospitals Antoine Béclère Hospital, 157 Rue de la Porte de Trivaux, 92140, Clamart, France. aurelie.forbes@aphp.fr.
Insights
Radiation doses in paediatric fluoroscopy vary significantly between hospitals, even for similar procedures. Optimizing imaging protocols and establishing dose reference levels are crucial for reducing patient radiation exposure.
Area of Science:
- Medical Imaging
- Radiology
- Paediatric Healthcare
Background:
- Paediatric gastrointestinal fluoroscopy examinations exhibit significant variability in radiation doses for comparable patient sizes and exam types.
- This variability poses challenges for consistent patient care and radiation safety.
Purpose of the Study:
- To investigate variations in imaging protocols, radiation doses, and image quality in paediatric fluoroscopy.
- To develop recommendations for harmonizing and optimizing local practices in paediatric radiology.
Main Methods:
- Retrospective data collection from five paediatric radiology departments on over 2,400 fluoroscopically-guided examinations (contrast enema, micturating cystourethrography, upper GI).
- Analysis of imaging protocols, radiation doses, and image quality using clinical and phantom images.
Main Results:
- Substantial patient dose variability (up to 5x) observed among centers for similar fluoroscopy times.
- Significant differences in fluoroscopy dose regulation and filtration protocols were identified.
- Image quality showed no consistent improvement with increased radiation dose, indicating potential for optimization.
Conclusions:
- Disparities in protocols and the lack of correlation between dose and image quality highlight opportunities for optimization.
- There is a clear need for guidelines on fluoroscopy image quality and dose reference levels in paediatric gastrointestinal examinations to standardize practices and minimize patient radiation exposure.
Background:
Paediatric gastrointestinal fluoroscopy examinations can impart varying amounts of radiation for the same patient size and exam type.
Objective:
To investigate the variability of imaging protocol, radiation dose and image quality in paediatric fluoroscopy examinations in order to provide recommendations for the harmonisation and optimisation of local practices.
Materials And Methods:
Five paediatric radiology departments performing fluoroscopically-guided contrast enema, micturating cystourethrography and upper gastrointestinal tract examinations participated in this study. Information on imaging protocols and radiation doses was retrospectively collected for more than 2,400 examinations. Image quality was analysed on clinical and phantom images.
Results:
Patient doses showed great variability among centers with up to a factor of 5 for similar fluoroscopy times. The five departments had imaging protocols with major differences in fluoroscopy dose regulation curves and additional filtration. Image quality analysis on phantoms and patients images showed no major improvement in contrast, spatial resolution or noise when increasing the radiation dose. Age-based diagnostic reference levels using both dose area product and fluoroscopy time were proposed per procedure type.
Conclusion:
Disparities between centers and no correlation of radiation dose with image quality criteria create margins for optimisation. These results highlight the need for guidelines on fluoroscopy image quality and dose reference levels in paediatric gastrointestinal examinations to harmonise practices and optimise patient dose.
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