The micro-angiographic fluoroscope (MAF) in High Definition (HD) mode for improved contrast-to-noise ratio and resolution in fluoroscopy and roadmapping

During image guided interventional procedures, superior resolution and image quality is critically important. Operating the MAF in the new High Definition (HD) fluoroscopy mode provides high resolution and increased contrast-to-noise ratio. The MAF has a CCD camera and a 300 micron cesium iodide x-ray convertor phosphor coupled to a light image intensifier (LII) through a fiber-optic taper. The MAF captures 1024 × 1024 pixels with an effective pixel size of 35 microns, and is capable of real-time imaging at 30 fps. The HD mode uses the advantages of higher exposure along with a small focal spot effectively improving the contrast-to-noise ratio (CNR) and the spatial resolution. The Control Acquisition Processing and Image Display System (CAPIDS) software for the MAF controls the LII gain. The interventionalist can select either fluoroscopic or angiographic modes using the two standard foot pedals. When improved image quality is needed and the angiography foot-pedal is used for HD mode, the x-ray machine will operate at a preset higher exposure rate using a small focal spot, while the CAPIDS will automatically adjust the LII gain to achieve proper image brightness. HD mode fluoroscopy and roadmapping are thus achieved conveniently during the interventional procedure. For CNR and resolution evaluation we used a bar phantom with images taken in HD mode with both the MAF and a Flat Panel Detector (FPD). It was seen that the FPD could not resolve more than 2.8 lp/mm whereas the MAF could resolve more than 5 lp/mm. The CNR of the MAF was better than that of the FPD by 60% at lower frequencies and by 600% at the Nyquist frequency of the FPD. The HD mode has become the preferred mode during animal model interventions because it enables detailed features of endovascular devices such as stent struts to be visualized clearly for the first time. Clinical testing of the MAF in HD mode is imminent.