The broad goals of the work are to significantly improve real-time fluoroscopic images while reducing the patient's radiation dose. The research may show that, by redistributing the x-ray photon fluence so that more photons are sent to a region of interest (ROI) and fewer to a region peripheral to the ROI, an improved image may be obtained in the region of clinical activity at a lower integral-dose. The specific clinical applications for the proposed research are interventional radiography and pediatric fluoroscopy. For the first, the aim is to evaluate how much better, and with what integral dose reduction a given interventional task can be accomplished if the real-time image in an ROI where the interventional action is occurring (i.e. near the catheter tip) is improved with the sacrifice of a degraded or noisier image in the periphery. Additionally, with a small ROI, small rotations of the x-ray beam about the treatment volume can spread the radiation over the entrance surface so that the common radiation induced clinical problems of skin reactions and hair loss may be eliminated without impacting the interventional procedure. For the second application, the aim is to evaluate the pediatric dose savings achievable using ROI fluoroscopy with no significant change in the diagnostic utility of the procedure. Specific goals include 1) construction of an ROI filter mechanism and 1000-line real-time digital subtraction system; 2) construction of vascular phantoms allowing evaluation of simulated interventional tasks for task accomplishment, duration of procedure, and integral and entrance dose saving with and without dose rate increase in the ROI, as a function of ROI filter parameters; 3) evaluation of ROI fluoroscopy for interventional tasks in a canine aneurysm model; and finally 4) a multi- site clinical study of ROI fluoroscopy. In order to determine the efficacy of ROI fluoroscopy, of necessity, the image quality requirements for clinical fluoroscopy and, in particular, for conducting interventional radiologic tasks will be analyzed. Ultimately, it is hoped that the research will lead to better utilization of ionizing radiation in medical diagnosis and intervention.

National Institute of Health (NIH)
National Institute of Neurological Disorders and Stroke (NINDS)
Research Project (R01)
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Diagnostic Radiology Study Section (RNM)
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State University of New York at Buffalo
Schools of Medicine
United States
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Rudin, S; Wakhloo, A K; Lieber, B B et al. (1999) Microdroplet tracking using biplane digital subtraction angiography for cerebral arteriovenous malformation blood flow path and velocity determinations. AJNR Am J Neuroradiol 20:1110-4
Rudin, S; Bednarek, D R; Yang, C Y (1999) Real-time equalization of region-of-interest fluoroscopic images using binary masks. Med Phys 26:1359-64
Wakhloo, A K; Lieber, B B; Rudin, S et al. (1998) A novel approach to flow quantification in brain arteriovenous malformations prior to enbucrilate embolization: use of insoluble contrast (Ethiodol droplet) angiography. J Neurosurg 89:395-404
Massoumzadeh, P; Rudin, S; Bednarek, D R (1998) Filter material selection for region of interest radiologic imaging. Med Phys 25:161-71
Granger Jr, W E; Bednarek, D R; Rudin, S (1997) Primary beam exposure outside the fluoroscopic field of view. Med Phys 24:703-7
Kezerashvili, M; Bednarek, D R; Rudin, S (1997) Automatic system for measuring dose-area product (DAP) in ROI fluoroscopy. Phys Med Biol 42:613-23
Kezerashvili, M; Rudin, S; Bednarek, D (1997) Automatic filter placement device for region of interest (ROI) fluoroscopy. Health Phys 72:141-6
Rudin, S; Guterman, L R; Granger, W E et al. (1996) Application of region-of-interest imaging techniques to neurointerventional radiology. Radiology 199:870-3
Fletcher, L M; Rudin, S; Bednarek, D R (1996) Method for image equalization of ROI fluoroscopic images using mask localization, selection and subtraction. Comput Med Imaging Graph 20:89-103
Rudin, S; Bednarek, D R; Kezerashvili, M et al. (1996) Clinical application of region-of-interest techniques to radiologic imaging. Radiographics 16:895-902

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