Radiation dose and image quality for paediatric protocols in a biplane x-ray system used for interventional cardiology have been evaluated. Entrance surface air kerma (ESAK) and image quality using a test object and polymethyl methacrylate (PMMA) phantoms have been measured for the typical paediatric patient thicknesses (4-20 cm of PMMA). Images from fluoroscopy (low, medium and high) and cine modes have been archived in digital imaging and communications in medicine (DICOM) format. Signal-to-noise ratio (SNR), figure of merit (FOM), contrast (CO), contrast-to-noise ratio (CNR) and high contrast spatial resolution (HCSR) have been computed from the images. Data on dose transferred to the DICOM header have been used to test the values of the dosimetric display at the interventional reference point. ESAK for fluoroscopy modes ranges from 0.15 to 36.60 mu Gy/frame when moving from 4 to 20 cm PMMA. For cine, these values range from 2.80 to 161.10 mu Gy/frame. SNR, FOM, CO, CNR and HCSR are improved for high fluoroscopy and cine modes and maintained roughly constant for the different thicknesses. Cumulative dose at the interventional reference point resulted 25-45% higher than the skin dose for the vertical C-arm (depending of the phantom thickness). ESAK and numerical image quality parameters allow the verification of the proper setting of the x-ray system. Knowing the increases in dose per frame when increasing phantom thicknesses together with the image quality parameters will help cardiologists in the good management of patient dose and allow them to select the best imaging acquisition mode during clinical procedures.

Objective: To present a methodology and experimental results to assess the influence, in terms of dose and image quality, of the antiscatter grid (AG) in a pediatric cardiology X‐ray system.Method: Entrance surface air kerma and image quality, using a test object and different added thicknesses of polymethyl methacrylate (PMMA), for three different acquisition protocols, were measured with and without the AG, for fluoroscopy and cine modes. The image quality parameters, signal‐to‐noise ratio (SNR), high‐contrast spatial resolution (HCSR) and two figures of merit (FOM) were evaluated.Results: The average bucky factor values measured during this experiment were 1.99, 2.49, 2.85, and 3.30, respectively for 4, 8, 12, and 16 cm of PMMA. SNR variations do not appear to be relevant when removing the AG. However, the use of AG improves HCSR significantly. Imaging the test object with 4 cm of PMMA seems appropriate without the AG, but for 8 cm (equivalent to chest thicknesses of 12 cm) and greater thicknesses, a good image quality would require the use of AG.Conclusions: The AG should not be used for neonates and very young children with chest thicknesses equal to or less than 6 cm and weight less that 6 kg.

Interventional cardiology procedures usually imply high doses to the staff, as paediatric cardiologists need to stay closer to the patient than during adult procedures. Also, biplane systems are used that imply an additional source of staff doses. The objective of this paper is to measure scatter doses in four X-ray systems, using polymethyl methacrylate phantoms with thicknesses ranging from 4 to 16 cm to simulate paediatric patients, for the different acquisition modes. Scatter dose rates measured at the position of cardiologist's eyes ranged from 0.8 to 12 mSv h⁻¹, and about twice the above values at lower extremities, as a linear function of the surface air kerma at the phantom, keeping the irradiated area constant. Therefore, the respective personal dose equivalent for the lens of the eyes may be around 0.5 and 1 mSv throughout the procedure, if additional protection is not used. Simultaneous cine acquisition in biplane systems yielded scatter doses to cardiologists, increased by factors from 5 to 21, compared with a single C-arm acquisition case and depending on geometry. Knowledge of scatter doses for different operation modes, patient thicknesses and the biplane operation should help paediatric cardiologists to adopt conservative attitudes in respect of their occupational radiation risks.