PERCEPTUAL COMPARISON OF PULSED AND CONTINUOUS FLUOROSCOPY

Pulsed fluoroscopy (hereafter called pulsed) at reduced acquisition rates, typically 15 acq/s (pulsed‐15), is proposed to reduce x‐ray dose in interventional procedures. However, since the human visual system (HVS) acts as a temporal low‐pass filter that interacts with such acquisitions, the proper dose for pulsed must be obtained in perception experiments. We determine the dose for low‐frame‐rate pulsed that gives visualization equivalent to that of conventional 30 acq/s fluoroscopy, hereafter called continuous. Computer‐generated phantoms are used. They consist of stationary, low‐contrast disks on a flat background containing Poissonnoise that mimics quantum noise in fluoroscopy. Image sequences are displayed on the video tachistoscope, a device with considerable display flexibility. Three experimental paradigms are used. (1) In a paired‐comparison study, pulsed and continuous are displayed side‐by‐side on the same monitor, and the visibility of a contrast detail phantom is compared. (2) Using this same display, subjects record the minimally detectable disk contrast (the min‐contrast measurement). (3) In a four‐alternative forced‐choice experiment, a disk is placed in one of four positions, and the subject determines the position of the disk. The methods are complementary—the forced‐choice experiment properly eliminates the subjectivity of the observer threshold while the paired‐comparison study is much more time efficient. With regard to pulsed and continuous comparisons, remarkable similarity is found between the supra‐threshold experiments (1 and 2) and the detectability experiment (3); i.e., the average absolute differences in the equivalent‐perception dose as determined by the three measures is approximately 3%. No difference is found between interlaced and noninterlaced display. A relatively small dependence of dose savings on disk size is found with larger disks giving increased dose savings. Average dose savings of 22%, 38%, and 49% are found for pulsed‐15, pulsed‐10, and pulsed‐7.5, respectively.