Physical Image Quality Metrics for the Characterization of X-ray Systems Used in Fluoroscopy-Guided Pediatric Cardiac Interventional Procedures: A Systematic Review

Abstract

Pediatric interventional cardiology procedures are essential in diagnosing and treating congenital heart disease in children; however, they raise concerns about potential radiation exposure. Managing radiation doses and assessing image quality in angiographs becomes imperative for safe and effective interventions. This systematic review aims to comprehensively analyze the current understanding of physical image quality metrics relevant for characterizing X-ray systems used in fluoroscopy-guided pediatric cardiac interventional procedures, considering the main factors reported in the literature that influence this outcome. A search in Scopus and Web of Science, using relevant keywords and inclusion/exclusion criteria, yielded 14 relevant articles published between 2000 and 2022. The physical image quality metrics reported were noise, signal-to-noise ratio, contrast, contrast-to-noise ratio, and high-contrast spatial resolution. Various factors influencing image quality were investigated, such as polymethyl methacrylate thickness (often used to simulate water equivalent tissue thickness), operation mode, anti-scatter grid presence, and tube voltage. Objective evaluations using these metrics ensured impartial assessments for main factors affecting image quality, improving the characterization of fluoroscopic X-ray systems, and aiding informed decision making to safeguard pediatric patients during procedures.

Keywords: image quality; interventional radiology; pediatrics.

Figure 1

Flowchart of the article selection process in the current systematic review following the PRISMA initiative.

Figure 2

(A) Individual risk-of-bias assessment for the articles included in the systematic review (Ubeda et al., 2017 [1]; Bor et al., 2016 [12]; De las Heras et al., 2016 [9]; Corredoira et al., 2016 [13]; Lubis et al., 2015 [5]; Ubeda et al., 2014 [2]; Ubeda et al., 2013 [4]; Kordolaimi et al., 2013 [19]; Ubeda et al., 2011 [8]; Vañó et al., 2010a [20]; Vañó et al., 2010b [6]; Gislason et al., 2010 [10]; Vañó et al., 2008 [11]; Vañó et al., 2004 [7]). (B) Summary graph depicting the results obtained for each evaluated criterion.