Comparison of beam-hardening and K-edge filters for imaging barium and iodine during fluoroscopy.

This study investigated the dose reduction performance of several beam-hardening and K-edge filter materials for the imaging of barium or iodine during fluoroscopy. A computer model was developed to simulate the effect of added filtration on entrance exposure rate (Xp), integral dose rate (Di), contrast (C), signal to noise ratio (SNR), imaging performance per dose (SNR2/Di), and tube load. The model incorporated the response characteristics, in both manual and automatic control modes of operation, of fluoroscopic systems to increasing or decreasing x-ray intensity at the input of the image intensifier. Input parameters to the computer model included choice of filter material and thickness, a barium or iodine test object, tube potential, phantom thickness, a CsI input phosphor, and a set of algorithms for controlling the fluoroscopic system. In all cases, the performance of systems with added filtration was judged with respect to a reference system operating under comparable conditions. In general, either beam-hardening or K-edge filters provided a significant reduction in entrance exposure and integral dose rates, but with an attendant increase in tube load. For a fluoroscopic system constrained to follow a representative automatic brightness control algorithm, added filtration provided a reduction in entrance exposure and integral dose rates for all phantom or uniformly distributed barium thickness. However, the imaging performance per dose, in some cases, decreased rapidly and was less than that of the reference system at large thicknesses. Only as change in the algorithm controlling the kVcp and mA operating points on the fluoroscopic system provided an imaging performance per dose greater than the reference system's at large thicknesses. The practical implementation of adding filtration to fluoroscopic systems is most simply accomplished with beam-hardening filters rather than K-edge filters. However, the systems with K-edge added filtration can provide slightly better performance when used over a limited range of phantom thicknesses such as the range normally associated with pediatric patients.